W. H. SHARP, M.D., of Volcano, W. Va.
HENRY A. SHELLEY, M.D., of New York.
ALLEN J. SMITH, M.D., of Philadelphia.
FRANK F. SMITH, M.D., of St. Augustine, Fla.
W. A. DE WOLF SMITH, M. D., of New Westminster,
B. C.

HALDOR SNEVE, M.D, of Dayton.

M. ALLEN STARR, M.D., of New York.

GEORGE M. STERNBERG, M.D., Surgeon U. S. A. DAVID D. STEWART, M.D., of Philadelphia. HENRY LING TAYLOR, M.D., of New York.

MAX THORNER, M.D., of Cincinnati.
R. D. WEBB, M.D., of Birmingham, Ala.
ROBERT F. WEIR, M.D., of New York.
H. R. WHARTON, M.D., of Philadelphia.
J. WILLIAM WHITE, M.D., of Philadelphia.
J. WHITRIDGE WILLIAMS, M.D., of Baltimore.
J. C. WILSON, M.D., of Philadelphia.
RANDOLPH WINSLOW, M.D., of Baltimore.
H. C. WOOD, M.D., of Philadelphia.
HUBERT WORK, M.D., of Fort Morgan, Col.
R. M. WYCKOFF, M.D., of Brooklyn.

VOL. LIV.

ORIGINAL ARTICLES.

A NEW STUDY OF LOBAR PNEUMONIA, WITH DEDUCTIONS FROM AN ANALYSIS OF FIFTY-FIVE FATAL CASES.1

BY THOMAS E. SATTERTHWAITE, M.D.,

PROFESSOR OF PATHOLOGY AND GENERAL MEDICINE IN THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL.

HISTORY tells us that in ancient times pneumonia was epidemic, and the Athenian plague that occurred in the year 430 B. C. was described as gangrenous pneumonia; and yet Thucydides claimed that it differed from other epidemics of pneumonia, and resembled typhoid fever; being characterized by ulceration of the bowels and excessive diarrhoea. On the other hand, the Black Death, that in the fourteenth century killed two-thirds of its victims, was associated with cough, bloody expectoration, vomiting and diarrhoea, buboes, carbuncles, and petechial spots. So, in the year 1557, during an epidemic that resembled typhus, in France, epidemic pneumonia was prevalent in Belgium. It occurred in September, after violent and cold north winds, and beginning with catarrhal affections was followed by cough and fever, pain in the side, and difficult respiration. Bloody expectoration occurred on the third day. In the year 1600 there was also a similar epidemic. Its symptoms were dyspnoea, cough and bloody expectoration, pleuritic pains, with delirium. The disease was thought by some to be contagious. In England many epidemics have been recorded as following influenzas, and Sturges (The Natural History and Relations of Pneumonia, London, 1876), to whom I am indebted for the instances just cited, gives a number of similar examples of socalled epidemic pneumonia.

In the majority of these instances, however, the diagnosis of pneumonia was not verified by postmortem examinations, which were rare in the earlier days of medicine; and even when made did not offer very satisfactory data for the modern pathologist; because the terms used were open to various interpretations. We may truly say that epidemic pneumonia does not prevail to any great extent at the present day; but at the same time a certain number of facts either appear to, or do actually indicate that it is occasionally epidemic. Thus Dr. H. J. Olklin, the inspecting medical officer of Iceland, 1 Read before the New York Academy of Medicine, December

20, 1888.

No. I.

in his report of an official visit to Iceland, in 1863, described an epidemic of pneumonia that he found prevailing there, and which he characterized as quite dissimilar from any disease he had seen previous to that time; though his experience covered a sixteen years' residence in foreign countries.

It may be true, then, as Dr. Sturges suggests, that the epidemics of pneumonia narrated by him did actually occur; the type varying with the locality. Thus, to give an instance, after the winter of 1708 -09, in France, an epidemic of pneumonia occurred in the provinces of Languedoc and Provence, but, on reaching England, shaded off into a widespread influenza. I might mention at this point that the late Dr. James Jackson, of Boston, in "Another letter to a young physician" (Boston, 1861), speaks of an epidemic that occurred in New England between 1812 and 1814. It was called, he says, peri-pneumonia notha, typhoid pneumonia, bilious pneumonia, etc. Post-mortem examinations, he tells us, showed that the inflammation was sometimes seated in the pleuræ; sometimes in the lungs; sometimes in the heart; or in two or more of these parts at the same time. The epidemic followed one of spotted or petechial fever. Of quite another character must have been the epidemic described by Dr. Darlington in a recent number of the Medical Record (Dec. 8, 1888), where twentyfive cases of lobar pneumonia occurred within ten days in a total of eighty men, who slept in a single room of a large shanty, and where the foul atmosphere and unsanitary conditions of the workmen. seem really to have produced an epidemic.