Pneumonia

Pneumonia is an inflammation of the lungs; it usually refers to lobar pneumonia, caused by pneumococcus germ and involving one or more lobes of the lung. If both lungs are involved, the condition is called double pneumonia. When the infection begins in the bronchial tubes and the inflammation involves small patches of the lung, we have bronchopneumonia. There are still other types of pneumonia owing to a variety of agents and causes. Some of these are described below.

Cold weather, particularly a change in weather from warm to cold, influences the development of pneumonia. This is true partly because the disease is often secondary to other infections of the upper respiratory tract, which occur more frequently in cold climates and winter months. Pneumonia is rare in the tropics.

Pneumonia is usually follows neglected cold, a mild bout of influenza – virus diseases – or other conditions that lower body resistance and permit the pneumococcus to get a foothold in the lungs. After a few days’ incubation, with symptoms much like those of a common cold, pneumonia comes on suddenly and abruptly. The early symptoms are shaking chills; high and rising fever; knifelike pains in the chest, side, or shoulder, which become worse with attempts to breathe deeply; a painful cough; blood-flecked or rusty sputum; and a very marked feeling of illness. Whenever this dangerous combination of symptoms appears, medical attention should be promptly obtained. Immediate treatment modifies the course of the disease.

If not treated with drugs, pneumonia runs a typical 7- to 10-day course. It comes to a turning point, or crisis, at which the patient may promptly recover, or die. During the course of the disease, the patient may get sicker and sicker and even go into delirium. Breathing is painful, rapid, and shallow. Pneumonia is no longer quite the dread disease it was before modern sulfa drugs and antibiotics. With proper modern treatment the disease can be brought under control in 12 to 36 hours.

What happens when the pneumococci invade the lungs is that the lungs try to drive them out by pouring out fluids (exudates). This mixture of serum, red and white blood cells, and fibrin fills the air sacs of the lungs (alveoli) and prevents the normal and necessary transfer of oxygen to the blood stream. When great amounts of fluid fill the air spaces, parts of the lung are consolidated into dense tissue, visible by X-ray. If a person dies of pneumonia, he has in effect drowned in his own body fluid.

When the physician listens with his stethoscope to the fluid-congested lung, he often hears a bubbly (bubbling râles) or musical sound (râles), as the air moving in and out of the lung riffles through the fluids. Because the fluids interfere with oxygen-transfer, the patient may begin to turn blue (cyanotic) and require an oxygen tank.

Bed rest and good nursing care are still needed in treating pneumonia, but they are not quite as important as they used to be when only expectant and symptomatic treatment was available. The chief agent of cure is now drugs, notably penicillin and other antibiotics, such as aureomycin; and sulfa drugs, such as sulfadiazine. These are given either alone or in various combinations. Administration of these drugs can quickly stop the spread of inflammation in the lungs. Temperature and breathing may become normal in a half day. Pain rapidly disappears; if it does not, the chest may be strapped or pain-killing drugs given. The patient must be kept under observation for some days to make sure that no further complications occur.

There is no widely practical method of specific immunization. The great hope of prevention lies in obtaining prompt treatment of the less serious upper-respiratory infections, like the common cold, sinusitis, bronchitis, and middle-ear infection, which are sometimes followed by pneumonia. Fatigue, chilling, poor nutrition, alcoholism, physical exhaustion and anything else that lowers bodily resistance should be avoided.

The other types of pneumonia are:

Hypostatic pneumonia usually occurring in elderly, bed-ridden patients whose lungs become congested because they have been lying flat on their back for too long.

Lipoid pneumonia, once common in young children. It results from inhaling oily nose drops into the lungs. This condition can be avoided simply by not using oily drops or sprays in the nostrils of infants and young children and be care in giving them cod-liver oil and other oily vitamin preparations.

Virus pneumonia, also called primary atypical pneumonia, which may be caused by any one of a number of viruses. It is characterized by fever, cough, and general weakness, lasts a long time and then disappears, does not respond to sulfa drugs and antibiotics. The viruses of influenza, psittacosis (parrot fever), and Q fever may produce a similar picture of illness.

Aspiration pneumonia, which sometimes follows inhalation of irritating fumes or a general anesthetic.

Besides the pneumococcus, the infecting agent in pneumonia can be streptococcus, staphylococcus, Hemophilus influenzae, or Friedlander’s bacillus.