Typhoid pneumonia is a term which has been applied to a variety of croupous pneumonia which is attended by typhoid symptoms. It has also been called asthenic, low, or nervous pneumonia. There are symptoms of extreme prostration from its onset. After well-marked pneumonic symptoms have been present for a few days, the patient passes into a condition of extreme prostration.
There is little or no expectoration, no dyspnoea, no pain, no cough. Sordes collect on the teeth and gums; the tongue becomes thickly coated with black crusts; the pulse becomes small, feeble, and rapid, and there is a tendency to the formation of bed-sores; and then occur stupor, somnolence, and a continuous low muttering delirium. This form of pneumonia is met with most frequently in the aged. In some cases there is marked disturbance of the special senses.
Tremors and subsultus tendinum frequently coexist. It may be accompanied by glandular swellings, by sharp and darting muscular pains, by arthritic symptoms, or by great gastric disturbance. It is not infrequent in epidemics, and it may follow or accompany erysipelas, Bright's disease, alcoholismus, or phlebitis. It is always a grave condition, but recovery is possible. Convalescence, which is very tedious, may commence as early as the twelfth or fourteenth day. Sometimes a modification of typhoid pneumonia accompanies dysentery, intestinal catarrh, or a phlegmonous gastritis. There are great sweating, profuse diarrhoea (colliquative), and high fever. The odor of the sputa resembles that of gangrene of the lungs. Such cases commonly end fatally.40
40 Cyclo. Pract. Med., iii., art. "Gastritis."
Bilious or Gastric Pneumonia.—Croupous pneumonia occurring in malarial districts, accompanied by gastro-enteric or hepatic symptoms, is known as malarial or bilious pneumonia. It has all the characteristic symptoms of pneumonia of a very severe type, but the fever is paroxysmal. The tongue is heavily coated; nausea and vomiting are common, and may persist throughout its entire course; the epigastrium is distended and tender; the skin is jaundiced; the liver is enlarged, and there is usually an exhausting diarrhoea, attended by greenish, black, viscid, and inodorous stools. The hepatic congestion and jaundice are due to a coincident gastro-duodenal catarrh.
Bilious pneumonia may be of a sthenic or asthenic type. The theory that the liver becomes inflamed by extension from the lung is untenable.
The symptoms of bilious pneumonia have frequently led to a diagnosis of typhoid gastric fever or some severe acute affection of the intestinal tract. But a reference to the physical signs will remove all doubts.
Bilious pneumonia runs a more protracted course and has a much longer period of convalescence than ordinary croupous pneumonia. In old age this form is not infrequent. The vomiting is distinctly bilious in character, and at this period of life somnolence and stupor are quite common, and are exceedingly unfavorable symptoms.
Latent Pneumonia.—Pneumonia in adults is seldom latent unless it complicates some disease whose symptoms are so severe, and the attending prostration is so great, as to obscure the characteristic signs of the pneumonia. Intercurrent senile pneumonia is always latent, and Grisolle says that an exploration of the thoracic organs in the majority of such cases gives negative results. If, then, an intercurrent senile pneumonia runs its course without expectoration, without dyspnoea, without the pneumonic flush, and without any of the physical signs of pneumonia, its diagnosis must rest—first, on the extreme frequency of pneumonia in old age; secondly, on the fact that of all the phlegmasiæ of advanced life pneumonia is the one which is oftenest latent; thirdly, that of all the acute diseases in old age pneumonia is attended by the highest range of temperature and the greatest prostration. When an old person has a slight rigor followed by febrile movement, with great prostration, for which no explanation can be found, pneumonia may be suspected, even though all its diagnostic signs are absent.
Intermittent or remittent pneumonia, which is described by some authors as a distinct type, is a form of acute pneumonia in which a malarial element is so pronounced that all the pneumonic symptoms, even the physical signs, undergo distinct intermission, returning each day with increasing severity. Occasionally, instead of the quotidian it assumes the tertian type. During the intermission the temperature may fall to normal. Severe chills and sweating are often present, and the pneumonia is not infrequently double.