The fever is frequently very violent, the pulse is frequent and quick, small and hard, the heat burning, thirst excessive, particularly during the exacerbation of the fever, towards night. The face and skin are not always red, but sometimes pale although very hot, or else there is a frequent alternation of paleness and redness; the mouth is hot, the tongue generally coated white and moist, the lips are dry and hot. Nursing infants occasion a feeling of disagreeable heat about the nipples. The breathing has frequently a disagreeable smell. The urine is dark-coloured, hot, has sometimes a sharp smell, and finally becomes thick and milky. The stool is irregular; at times undigested, light-green, accompanied with pinching, slimy, diarrhaeic; at other times there is constipation. During the course of the disease there is no general sweat, mostly only about the head and chest; if a general sweat should break out, the disease is broken.

medies indicated for that species of pneumonia are principally those which we employ in typhoid affections, and which at the same time correspond to inflammatory diseases of the chest, such as, Bryon., Bellad., Rhus t, Nux vom., Mercur., Arnica, Puls., Baryta, Conium. An excellent remedy is Tartar emet., which is, perhaps more than any other remedy, capable of preventing paralysis of the lungs, and is a specific remedy for the sopor generally attending that kind of pneumonia. It is scarcely necessary to state, that all the other remedies which have been proposed for typhoid affections in preceding chapters, may likewise prove useful in the treatment of asthenic pneumonia.

I have lately treated a case of pneumonia with or-thopncea, in a patient of advanced age, where Bryon., Rhus t., Bellad., Phosph., were of no avail: the cure was effected by repeated doses of the third attenuation of Cannabis.

§ 140. Pneumonia is sometimes complicated with gastric, bilious and mucous fevers, in which case the remedies indicated for pneumonia and the accompanying affections have to be used.

The treatment of the secondary affections arising from pneumonia will be discussed hereafter. We may here state, however, that Lycopodium has proved curative in several cases of pneumonia where the disease threatened to run into phthisis, and that Nitric acid, Tart, emet., Kali carb., etc., have been found useful in the treatment of empyema.

We ought to observe that auscultation and percussion should be instituted every day until the patient is entirely restored. The abnormal physical symptoms disappear in an opposite order to that of their development: bronchophony gives place to the rattle, the whiffing or crepitant rattle to the mucous rattle, this to the normal vesicular breathing; the percussion-sound from dull again becomes clear.

§ 141. There is another species of pneumonia which goes by the name of false or occult pneumonia (pneumonia notha, occulta). It frequently sets in so clandestinely that the patient is not aware of it. It is sometimes preceded by lassitude and heaviness of the limbs, or it sets in in the shape of an ordinary catarrh of the lungs, with alternate chilliness and heat, without cough. The cough is generally moist, even from the commencement of the disease; the expectoration is white, yellow, slimy, sometimes it consists of a little froth only, but is never thick and compact; there are cases where the cough is dry, and the patient coughs constantly and violently, as if his chest and head would fly to pieces from pain. The breathing is impeded, with slight pressure or stinging and burning sensations here and there in the chest, which go and come and always appear at the same narrow spot. These paroxysms of anxiety and fleeting pains increase on going up stairs, sitting erect or turning to either side, so that the patient is frequently compelled to lie on his back all the time. The disease is frequently accompanied with all sorts of catarrhal and rheumatic symptoms. Fever is almost always wanting, or, when present, it is very slight and scarcely ever violent. The pulse is somewhat increased, feeble, the cheeks are but slightly reddened, the thirst is very little, and the appetite and general health continue good. The disease generally appears in old people, and inclines to terminate in complete paralysis of the lungs, suffocative catarrh (ca-tarrhus suffocativus).

§ 142. A most excellent remedy for this kind of pneumonia is Arnica, particularly when the fever is slight; the internal chest feels as if bruised, the cough is not too frequent, and accompanied with scanty, somewhat blood-streaked, slimy, expectoration. In some cases Bryonia is preferable, particularly when the pains and suffocative symptoms increase at night, with great heat in the chest, violent cough, as if the head and chest would fly to pieces, with scanty expectoration of dingy-reddish mucus.

Pulsatilla is indicated by profuse white-yellowish expectoration, loose cough, which does not fatigue the chest. If these symptoms should have become chronic, with predominant inflammatory character, Dulca-mara sometimes renders essential service.

If the cough be dry, with much tenacious mucus in the larynx and trachea, and a good deal of rattling, causing aching pains in the chest, and as if it would fly to pieces, Senega is an excellent remedy; whereas Nux. vom. is more indicated by a dry, spasmodic cough, accompanied with oppression of the chest, or difficult respiration.

Sulphur, Lycop., Calc, etc., and the remedies indicated for pneumonia generally, may prove useful under certain circumstances. § 143. Pleurisy, Pleuritis.

Pathognomonic symptoms: Rather superficial violent stitch, emanating from a certain part of the chest, generally below or sideways from the nipple, extending over a large portion of the chest, and increased or excited by deep breathing; if the pleura costalis should be affected, the pain will likewise be increased by pressure on the intercostal muscles. The breathing is short, hurried, incomplete; sometimes the patients donot experience any pain on raising the thorax partially, but if a large portion of the pleura should be affected, respiration has to be carried on with the abdominal muscles; nevertheless, there is not as much anxiety as in pneumonia. The cough is short, generally dry or attended with mucous expectoration: if the inflammation should communicate itself to the lungs, the sputa becomes frothy, or like saliva, tenacious, and blood-streaked. The cough occurs either spontaneously or in consequence of talking, or deep breathing. Lying on the affected side increases the pain very much.

If the mediastinum posticum be the seat of the inflammation, there is less difficulty of breathing, but the pains along the whole vertebral column are gnawing and dull, and increase on moving the dorsal vertebrae. The pain frequently extends up to the throat, preventing deglutition; disposition to vomit and real vomiting are likewise frequently present.

The fever is generally moderate, and frequently precedes the local symptoms; the pulse is tight, and frequently small, in consequence of the imperfect breathing.

All these symptoms, however, are more or Jess deceitful, without the physical symptoms; they very often characterize an affection of the pulmonary tissue itself. The physical symptoms depend upon the exudation which accompanies every case of pleurisy. If the exudation be not too inconsiderable, the affected side of the thorax is raised very little, or not at all, during an inspiration, and seems to have increased in size in consequence of the extension of the intercostal muscles: the wall of the thorax does not vibrate when talking; the vesicular murmur from below upwards is entirely wanting, and the apex of the heart is pushed somewhat out of its place, and does not strike the thorax at the normal point; the diapraghm and the liver are somewhat crowded out of their normal positions.

The percussion-sound is always dull and hollow, and if the exudation should be of a fluid consistence, the sound changes according to the position of the patient. Auscultation does not yield constant symptoms.

Previous to the introduction of auscultation and percussion, the empyema was diagnosed from the following facts: previously existing pleuritis, rupture of a vomica, dull pressure on the chest, with violent dyspnoea, immobility of the affected side of the thorax, oedema of that side and of the back, position of the patient on the affected side and on the back, increase of the dyspnoea when lying on the sound side of the chest, swelling of the arm of the affected side, feeling of fluctuation in the chest on changing one's position, hectic fever, sedimentous and fetidly-smelling urine.

The exudation continues and develops itself together with the local inflammation.

§ 144. If the fever be a synocha, and the sticking pains very acute, Aconite sometimes cures the whole disease; if any pain should be left, Bryonia will remove it. If the exudation should be considerable, (see physical signs,) Arnica, Sulphur, or Scilla will promote the absorption, and soon remove the disease. Characteristic indications for Arnica is the uneasiness in the affected side of the chest, inducing constant changes of position: accompanied with a feeling in the chest as if bruised, which constantly invites the patient to lie down, accompanied with general internal heat and cold feet and hands, or else the patient complains of a stinging pain in one side of the chest, with dyspnoea, and a frequent, short, and dry cough, which increases the pain very much.

Scilla is suitable, when there is a dry, burning heat, with chills on uncovering any portion of the body ever so little, attended with violent stitches in the side striking from the ribs to the shoulder, and increased by the cough, which is generally accompanied with profuse expectoration of mucus.

Sulphur, Rhus t., Nux v., Kali curb., and Bell., arc useful when the inflammation has communicated itself to the lungs. In some kinds of muscular pleuritis, particularly when there is no inflammatory fever, no thirst, when the patient complains of coldness, and at times only of flushes of heat, which are generally occasioned by the increased pain and the subsequent anguish, Sabadilla will prove useful.