PATHOLOGY AND PRACTICE OF MEDICINE.
Contribution to the Pathological Physiology of Pneumonia. By Dr.
G-. Zimmermann.—Zimmermann considers the most minute observa-
tion of the natural course of acute disease to be the only way of eluci-
dating the laws of these typical processes. Although he thinks those
cases most fit for the purpose in which no remedies are employed, yet he
does not at all exclude those in which the treatment is active. As an
instance of how to observe, he describes the course of a case of pleuro-
pneumonia, treated by repeated venesection, application of blisters, and
internal administration of antiphlogistic remedies, in moderate doses.
From the first day of the fully established disease, till after the return
of convalescence, he has noted twice daily (at 8 A. M. as the time of
remission, and between 5 and 6 P. M. as the time of exacerbation) the
temperature under the tongue, the frequency and other qualities of the
pulse, and the number of inspirations on almost every day, the quantity
of urine secreted in 24 hours, its specific gravity, and the quantity of
lithic acid contained in it. Of great interest are the critical symptoms,
remarked on the 3d and then again on the 9th day, after which we ob-
serve a steady progress to convalescence. The first note on the tempera-
ture was taken four hours after an attack of general vehement rigors,
which the patient himself considered as the commencement of the dis-
ease; it was then as high as 10yO10, which, being 4° 14, over the
normal warmth of that individual (98°96,) makes Zimmermann inclined
to conclude, that the disease had commenced before the occurrence of
the rigors. Between the evening of the 2d and the morning of the 3d
day, a (Jecrease from 104°0 to 99°87 was observed, coincident with a
general abatement of the constitutional symptoms of pyrexia, but on the
evening of the 3d day, the temperature was again as high as 105°80
and the physical examination exhibited the signs of hepatization, which
had not been present in the morning. Between the evening of the Sth
and the morning of the 9th day, the warmth had decreased from 106°16
to 99°50 : at the same time all the other febrile symptoms disappeared
almost completely, after they had reached a very high degree on the two
previous days. It is interesting to remark, that although the frequency
of the pulse did not exceed the normal average after that period, yet the
temperature increased again to 102°20, and remained so for more than
a fortnight longer. The entrance of the change on the 9th day, does
not appear to Zimmermann as merely accidental, but he looks at this
day as a critical one; and also the coincidence of several alvinc evacua-
tions effected by calomel seems important to him, as lie thinks that the
crisis may be promoted by our remedies, if their action takes place
shortly before or on the beginning of a critical day. Concerning the
urine, the quantity secreted in twenty-four hours was between 9040 and
29,030 grains; the minimum is noted on the 5th, the maximum on the
9th day; the average quantity of 24 hours before the 10th day, was
15,215 grains, with an average specific gravity of 1-0198; between the
10th and the 40th day, 16,510 grains, with 1-0208 specific gravity. The
quantitative examination for urea was not made before the 8th day, on
which 1081 grains were contained in the urine in 24 hours; on the 9th
day, only 884 grains; and a few days later, not more than 400 grains
(which is about the average quantity during health—Lehmann, Physiol.
Chem., vol. i. p. 167.) The quantity of uric acid was almost normal
during the commencement of the disease, but after the sixth day it ap-
peared considerably increased, and reached the maximum on the 9th
day, when it amounted to 3770 grains in twenty-four hours (which is at
least three times more than the average during health—Lehmann, 1. c.
p. 217.) Zimmermann considers this increase of the uric acid and its
salts, at the period of the critical change, as important for the doctrine
of crisis, as he had opportunity to observe the same phenomenon, not
only in pneumonia, but also in typhoid fever, ague, measles, &c. From
three examinations of the blood obtained during the first seven days in
this case, and from his previous experience, Zimmermann considers as
the most important changes in the inflammatory blood—that it is less
coagulable than the blood in health; that the quantity of fibrine is aug-
merited; that the colored blood-globules are diminished in number, and
possess an abnormal disposition for the formation of rolls; that the
colorless globules are found in an increased proportion, and snow, like-
wise a tendency to join in groups.—Brit, and For. Medico-Chirurg.
Rev., from Prager Viertiljahrschrift.