. Medical diagnosis for the student and practitioner. e degree of contagiousness varieswith the type of organism present in the given case. Cold in itself must be regarded merely as a means of depressing vitalityand lowering resistance and is more potent when combined with dampness. City dwellers are much more subject to the disease than are those livingin the open country. Antecedent Disease.—Coryza and bronchitis often precede an attack,25 Rapid changes. Associatedconditions. Males Season andaltitude. Habits. Fatigue andexposure. Cold merelycontributory. Coryza andbronchitis. 38
. Medical diagnosis for the student and practitioner. e degree of contagiousness varieswith the type of organism present in the given case. Cold in itself must be regarded merely as a means of depressing vitalityand lowering resistance and is more potent when combined with dampness. City dwellers are much more subject to the disease than are those livingin the open country. Antecedent Disease.—Coryza and bronchitis often precede an attack,25 Rapid changes. Associatedconditions. Males Season andaltitude. Habits. Fatigue andexposure. Cold merelycontributory. Coryza andbronchitis. 386 MEDICAL DIAGNOSIS Chronicailments. Complicating. Hypertoxiccases. and no doubt furnish a favorable soil for the further development, increasedvirulence and wider dissemination of pneumococci. Terminal Pneumonias.—Chronic disease may play a prominent part,and pneumonia is a frequent terminal event in acute or arrested pulmonarytuberculosis, chronic nephritis, diabetes, carcinoma, arteriosclerosis, prostatichypertrophy and chronic heart Fig. 149.—Lobar pneumonia in child five years old. Upper right lobe involved. Noclear physical signs. Patient roentgenized to determine cause of high temperature. Reso-lution by crisis on ninth day. Apparent cardiac displacement represents distortion of out-line due to faulty position of child at the moment of exposure. Probably a massivepneumonia, i. e., one with blocked bronchi. (Dr. Frank S. Bissell.) VARIETIES OF PNEUMONIA.—Pneumonia may complicate any acuteinfectious disease and is especially frequent in influenza. The term u typhoidpneumonia should be confined to pneumonia with an overwhelming toxemiawhich produces a typhoid state, not to pneumonia complicating typhoid fever. DISEASES OF THE LUNGS AND PLEURA 387 Traumatic, Migratory, and Massive Forms.—Traumatic pneumonia israre and migratory pneumonias are both unusual and interesting. Massive pneumonias are sometimes encountered in which the large bron-chi are plugged
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