Pneumonia was once one of the most feared of all human diseases. Its death rate was about a third of all those whom it attacked. The germ that caused it is one called a "pneumococcus" which lives ordinarily in the noses and throats of anywhere from five to sixty per cent of people. The condition comes on most often in the winter months and can affect people of all ages.

The pneumococcus gets down into the lungs and there sets up a severe infection which follows a typical course. For a few days the symptoms are like those of an ordinary respiratory disease. Then comes the sudden hard, shaking chill, rapid rise in temperature and pulse rate, with a severe pain on one side of the chest that the doctor recognizes as the beginning of pneumonia. The cough comes on painfully and with small amounts of pink or rust-colored sputum. Breathing is rapid, shallow and painful. There may be blueness because the blood is not getting enough oxygen.

The doctor, by the use of his stethoscope and by watching the motion of the chest, by thumping to discover areas of consolidation, recognizes that the lung is congested and unable to function. Usually after seven to ten days a crisis occurs. The body temperature falls to normal in from six to twelve hours, accompanied by profuse sweating, and the pneumonia as such is over.

The development of the new antibiotic drugs has changed the whole picture. Now, following the administration of penicillin, the pain in the pleura which lines the chest disappears in a few hours and the temperature, pulse, and respiration fall to normal in twelve to thirty-six hours.

The spread of the inflammation can be stopped even before a single lobe is involved. This change in the nature of pneumonia is one of the most dramatic occurrences that has ever taken place in medicine and represents one of the greatest accomplishments of the present century.

For the treatment of pneumonia nowadays the chief reliance is on the drugs. The patient is kept in bed in a position in which he is most comfortable. He is given considerable rest but is permitted to sit up for examinations and for any other necessary procedure. He usually has little appetite and need not be urged to eat, but within a half a day after the specific treatment has been begun, he may be hungry and can take a soft diet. Formerly great efforts were made to keep the bowels moving; that too is no longer a serious problem for the doctor. If there is a real shortage of air and the person seems blue, oxygen can be given. It is customary to give oxygen now as soon as it is needed and not to wait until the patient seems actually to suffer from oxygen lack.

The pain in the chest can be controlled with suitable drugs. It is also possible to relieve severe pain by the injection of local anesthetic drugs or by strapping or wrapping the chest wall to prevent unnecessary motion.

The doctor is alert for complications. If penicillin is not as effective as seems to be desirable, aureomycin, the sulfonamides, such as sulfadiazine, and other methods may be tried. Particularly, however, the doctor must look out for complications such as secondary formation of pockets of infected material at the bottom of the lung.

The former fatality rate of 25 to 30 per cent has now dropped to less than 5 per cent. Pneumonia is still a particularly serious disease to those who have been long weakened by some other disease such as cancer or alcoholism or malnutrition, or some other serious complication involving the heart.

Bronchitis

Any of the germs that get into the nose and throat may secondarily invade the lung or -the bronchial tubes and set up the inflammation called "acute bronchitis." This usually starts gradually with frequent coughing that is more severe at night. Slight fever may be present. If the amount of debris and infected material is profuse the coughing will raise a thick material that has to be expectorated. Young children do not spit, but swallow the material and then frequently vomit to get rid of it.

Bronchitis is not really a disease in itself, but far more often a complication of a common cold, influenza, measles, rhinitis, diphtheria, scarlet fever or rickets. Prompt attention to these conditions with special consideration for the inflammation that has extended into the lungs will help to prevent acute bronchitis and may do much to stop its becoming chronic. Bronchitis is chiefly dangerous to little children, and continuous inflammation with much coughing may make desirable removal to a warm climate to help the child get rid of the infection.

Since inflammation becomes worse when tissues are irritated, people with chronic inflammation of the bronchial tubes should avoid contact with irritating dusts, fumes, gases, or paints. Tobacco smoking must be stopped. The infected individual does better in a clean atmosphere where the air is neither too cold, too damp, too warm nor too dry.

All sorts of cough mixtures are known that will increase the flow of mucus and make the raising of the sputum easier. Inhaling steam seems to help many people. If there is sensitivity the use of antihistaminic drugs may be helpful and may aid also by a sedative effect.