Excerpt from Practice of Medicine: Part II., Or Special Pathology, Continued; Class III., Or Local Diseases, Continued

The three diflerent conditions just described are sometimes, but not al ways, distinct. They are in fact often more or less intermingled. Thus, in the midst of a congested portion of the lungs, some spots of red hepatization may appear, and, in the midst of the latter, some spots of gray hepatization, which give a mottled appearance to a section of the diseased lung. Some times the three conditions exist at the same time, the gray hepatization being in the centre, the red around it, and the congestion on the borders of the latter, though the boundary between them is not accurately defined. In relation to the pathology of these difl'erent conditions, it may be sumcieut to state that, in the first, the vessels are merely engorged with blood, and the air-cells partly filled with a sore-mucous, somewhat bloody efl'usion; in the second, a plastic extravasation has taken place, and the cells, as well as the intercellular tissue, are filled with a more or less concrete and bloody lymph; in the third, the place of the plastic secretion has been supplied by a purulent fluid. The pleura is very frequently, but not always, inflamed over the hepatized portion of the lung. Coagulable lymph is often thrown out, forming a false membrane upon its surface; and sometimes the two opposite surfaces adhere; while a little turbid serum is found in the pleural cavity. In some instances, the ih flammation of the pleura is much more extensive; and then the disease comes under the designation of pleuro-pneumonia. (see Pleuro-pneumonia.) The bronchia, both large and small, are almost always inflamed, containing mucus, and exhibiting a reddened surface; and if one lobe is inflamed, the bronchial tubes going to that lobe are also afl'ected. The bronchial glands are often on larged, reddened, and softened. The right cavity of the heart frequently con tains red and soft, or yellowish and firm coagula.

In a great majority of cases, the morbid phenomena are confined to one lung; and the right lung is much more frequently afl'ected than the left. From a comparison of 1430 cases, collected by M. Grisolle from various authors, it ap pears that the cases of double pneumonia were about 18 per cent. Of the whole number, those of the left side about 30 per cent., and those of the right side about 52 per cent. In secondary pneumonia, the opposite sides appear to be about equally afi'ected. In relation to the part of each lung attacked, Laen nec stated that the lower portion was most frequently the seat of the inflam mation, and that when this occupied the whole lung, it almost always began in that portion. Some have considered the lower and middle parts as almost the exclusive seats of the incipient inflammation. It is probably true that these are most frequently afi'ected; but observation has shown that the disease not unfrequently also begins in the upper lobe; and in certain seasons this ap pears to be oftener the case than in others, without any known cause for the difi'erence. Of 264 cases investigated by M. Grisolle, the inflammation began in the lower lobes in 133, at the summit in 101, and at the middle in 80.

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