PNEUMONIC FEVER- 
ITS MORTALITY. WITH A CONSIDERATION 
OF SOME OF THE ELEMENTS 
OF PROGNOSIS. 
BY 
EDWARD F. WELLS, M.D., 
OF CHICAGO, ILL. 
Read before the Chicago Medical Society, December 7,1891, 
Reprinted from the "Journal of the American Medical Association," 
January 9,1892. 
CHICAGO: 
PUBLISHED AT THE OFFICE OF THE ASSOCIATION. 
1892. PNEUMONIC FEVER-ITS MORTALITY. WITH 
A CONSIDERATION OF SOME OF THE 
ELEMENTS OF PROGNOSIS. 
BY EDWARD F. WELLS, M.D., 
OF CHICAGO. ILL. 
The death-rate of pneumonic fever varies, accord- 
ing to the statements of authors, from nil to 100 per 
cent. I have collected and tabulated the statistics of 
223,730 cases of this disease, of which number 40,276 
perished from the direct effects of the malady-a rate 
of 18.1 per cent. These cases have been drawn from 
every available source, from all parts of the world, 
and have been subjected to every imaginable mode 
of treatment. Numerous schools of medical philos- 
ophy, and eras of fashion in therapeutics, have also 
passed through the various stages of their existence 
during the period of time covered by this inquiry. 
Notwithstanding this, it will be noticed that the 
death-rate of all the larger collections of cases-with 
few exceptions-is nearly the same, although they 
were probably subjected to widely different, possibly 
diametrically opposite, methods of therapeusis. From 
this we may infer that treatment alone has exercised 
but little influence over the natural course of the 
malady, and that the results of this analysis fairly 
represent its normal fatality. In addition, we have 
an indirect mortality of about 1.3 per cent, from cases 
followed by dependent chronic ailments, which, added 
to that from the disease per se, raises the true? mor- 
tality rate to about 19.4 per cent. 2 
Before giving the table, we will pass in review the 
published opinions of a few authorities on this sub- 
ject: Bennett1 considers the mortality of uncompli- 
cated cases, properly treated, as being practically nil, 
and this opinion is shared by Barthez,2 Joly,3 Palmer,4 
Paton,5 Thomas6 and others. Ziemssen7 says that 
" according to his observation, primary croupous 
pneumonia in children almost always ends in recov- 
ery." Raven8 says that it "ends satisfactorily in a 
large majority of instances-children scarcely ever 
die of it." Trousseau9 says that "generally speaking, 
there is a tendency to spontaneous recovery," and 
similar words are used by Baginsky,19 Flint,11 Waters12 
and many others.13 D'Espine,14 Hartshorn,15 Wood,16 
and numerous other writers,17 consider the fatality as 
very light. Gerhard18 and others19 affirm that the 
death-rate in private practice should not exceed 2 or 3 
per cent. 
We hear much of the innocuity of simple pneu- 
monic fever, and in the fatal cases, how frequently 
do we find death attributed to " complications." As 
a matter of fact, cases are continually finding their 
way in significantly large numbers to the post-mor- 
tem table, with no other lesions except those legiti- 
mately belonging to the disease, showing that the 
malady is dangerous. 
Copland,20 Drake,21 Mann22 and others23 consider 
pneumonic fever a very fatal disease. Gross24 says 
that it is one of the " most formidable maladies 
which the physician has to cope with, and forms one 
of the great sources of mortality." Loomis25 says 
that "the mortality average from all the published 
reports to which he has had access, gives 20.1 per 
cent, of deaths. . . From such facts it must be ad- 
mitted that a disease in which death occurs in one 
out of five cases, should be classed among the very 
fatal diseases." Drummond25 looks " upon pneumo- 
nia as one of the most fatal of acute diseases." 3 
Donaldson,26 Hart,27 Sturges28 and others, think that 
the mortality has greatly decreased in recent years, 
whilst Hartshorn29 and others30 hold the opinion that 
it has greatly increased. The statistics presented in 
the following table will show that neither of these 
propositions are established by the facts in the case. 
Table I.-Showing Death Rate of Pneumonic Fever. 
CQ 
Per 
Observer and Reference. 
Cases. 
Cent 
Acerbi, Annot. di Med. Prac., Milano, 1819, p. 94 . . . 
142 
16 
11.2 
Antonin, Inaug. Dissert., Bucharest, 1887 
142 
2 
1.4 
Armstrong, U. S. Marine Hosp. Rpts., 1886, p. 129 . . . 
36 
11 
30.6 
Baginsky, Pneumonie u. Pleuritis, Wiirzb., 1880 . . . 
199 
49 
24.6 
Bamberger, Wiener med. Wochenschr., 1857, Nr. 5 . . 
60 
4 
6.7 
Bang, Ranking's Abst., No. 28, p. 92 
54 
2 
4.0 
Banks, U. S. Marine Hosp. Rpts., 1888, p. 226 
8.011 
496 
16.0 
Bartels, Ann. d. Charite, Bd. vii, S. 234 
161 
21 
19.4 
Barthez, Bull, de 1'Acad. de mdd., 1862, T. xxvii,p.676. 
212 
2 
1.0 
Basel Hospt., Beriehte 
922 
213 
23.1 
Bauer. Beriehte med. Klin. Munchen, 1878 
109 
21 
19.1 
Baumgartner, Lungenentziindung, Stuttg., 1850 .... 
Becquerel, Sur 1'influence des emiss, du sang, Paris, 
30 
3 
10.0 
1838 
28 
23 
82.0 
Bell, Braithwaite's Retrospect, Jan., 1859, p. 71 . . . . 
36 
0 
0.0 
Bell, Ranking's Abst., No. 28. p. 92 
81 
4 
5.0 
Bennett, Lancet, 1865, Vol. 1, p. 195 
129 
4 
3.1 
Berliner Charite, Annalen, 1876-7 
567 
lift 
19.8 
Besnier, Quoted bv Lupine, Pneumonie, Wien, 1883. . 
2,109 
759 
36.0 
Biermer, Quoted bv Kocher, Pneumonie, Wiirzb., 1866 
60 
10 
16.6 
Bird, Bouchet's Dis. Chest., London, 1865, p. 320 . . . 
20 
0 
0.0 
Bleuler, Inaug. Dissert., Zurich, 1865 
228 
44 
19.3 
Borland, Boston City Hosp. Rpts., 1870 
190 
27 
14.2 
Bouillaud, Die. de mdd., Paris, 1835 . . 
173 
21 
12.1 
Bouillaud, Quoted by Sturges, Pneumonia, p. 206 . . 
102 
12 
12.0 
Brandes, Virchow's Archiv., Bd. xv, S. 210 
142 
30 
21.1 
Brenchley, Lancet, 1890, Vol. I, p. 1425 
Briquet, Ranking's Abst., No. 28, p. 92 
British Army, LaRoche, Pneumonia, Phila., 1854, p. 417 
12 
0 
0.0 
129 
17 
13.2 
5,685 
399 
7.0 
Burkard, Ranking's Abst., No. 28, p. 92 
120 
2 
1.6 
Caton, Lancet, 1884, Vol. II, pp. 135-137 
129 
39 
30.0 
Chatelain, Jour, de m£d. de Brux., 1870 
39 
20 
52.0 
Chomel, Pneumonie, Leipzig, 1841, S. 305 
383 
(50 
15.7 
Churton, Lancet, 1890, Vol. II, p. 133 
Chvostek, CEsterr. Zeitschr. f. prak. Heilk,, 1867, Nr. 
127 
19 
15.0 
26, S.43 
209 
36 
17.2 
Cincinnati Bd. Health Rpts., 1873-74-75 
260 
50 
19.2 
Cincinnati Hosp. Rpts., 1874-75 
124 
41 
33.0 
Cohn, Ranking's Abst., No. 28, p. 92 
57 
24 
42.0 
Coleman, Inaug. Dissert., Wiirzb.. 1886, S. 13 
25 
3 
12.0 
Colin, Etudes clin. de med. mil.. Paris, 1863 
74 
4 
5.2 
Collective Investigation Record, London, 1884, Vol. II 
Colles, U. S. Naval Rpts., 1881, p. 414 
1,065 
192 
18.0 
517 
116 
22.4 
Cook Co. Hosp., Rpt. first half 1890, p. 36 
134 
49 
14.4 
Couldrey, Lancet, 1888 
10 
1 
10.0 4 
Observer and Reference. 
Cases. 
Deaths 
Per 
Cent 
Croce, Deutsches Arch, f. klin. Med.,Bd. xxxviii, S. 554 
610 
98 
16.0 
Dalton, St. Louis Med. Rev., Mar. 30,1889, p. 355 . . . 
124 
45 
36.3 
Davis, Cincin. Lancet and Clinic, July 5, 1890, p. 9 . . 
15 
1 
6.6 
De Bordes, Nederl. Weekbl. voor Genes., Jan., 1855 . . 
90 
19 
21.0 
Derpmann, Inaug. Dissert., Bonn, 1885, S. 19 
655 
117 
17.9 
Dessau, Jour. Am. Med. Assoc., Nov. 29, 1890, p. 791 . . 
45 
0 
0.0 
Dietl, Wiener med. Wochenschr., 1852 
750 
69 
9.1 
Dietl, Ranking's Abst., No. 28, p. 92 . . . 
1,130 
122 
11.0 
Doubleday, N. Y. Med. Rec., Mar. 28, 1885, p. 343 . . . 
252 
112 
44.4 
Dutcher, Cm. Lancet and Obsv., Jan., 1861, p. 10 . . . 
50 
1 
2.0 
80 
4 
5.0 
Emmerich, Arch. f. Hygien., 1884, Bd. ii, Heft. 1 . . . 
161 
46 
28.6 
Feldhausen, Inaug. Dissert., Gottingen, 1879, S. 15 . . 
56 
y 
12.5 
Fenwick, Lancet, Jan. 31 and Feb. 7,1891 
990 
233 
23.5 
Fieandt, Helsingfors Duodecim, 1889 
106 
3 
2.8 
Fisher, N. Y. Med. Rec., July 28,1889, p. 94 
26 
1 
4.0 
Fismer, Deutsches Arch. f. k. Med., Bd. xi, 1873 . . . 
145 
13 
9.0 
Fleischmann, Quoted by Sturges, Op. cit., p. 329 . . . 
Flint, N. Y. Med. Jour., Mar., 1875, p. 290 
239 
133 
14 
35 
5.8 
26.3 
Folkmann, Inaug. Dissert., Erlangen, 1847, S. 39 . . . 
125 
26 
20.8 
Forget, Gaz. m£d. de Strasb., 1860 
32 
7 
2.0 
Fox, Reynolds' Syst. Med., Phila., 1880, Vol. II, p. 204. 
55 
8 
14.5 
Franque, Statistik d. Pneumonie, Wiirzb., 1855 .... 
872 
. 262 
30.0 
Fricke, Inaug. Dissert., Gottingen, 1886, S.26 
179 
16 
9.0 
Frohmiiller, Deutsche Klinik, 1855 
12 
0 
0.0 
Funck, Inaug. Dissert., Griefswald, 1868 
941 
102 
10.8 
Gandini, Ranking's Abst., No. 28, p. 92 
2D 
0 
0.0 
Gentile, Laennec's Dis. Chest, N. Y., 1830, p. 270 . . . 
40 
1 
2.5 
Gerhard, Am. Jour. Med. ScL, Vol. XIV, p. 328 .... 
41 
1 
2.5 
German Army, Hermann, Lungenentziindung, 1880. . 
Green, N. Y. Med. Rec., July 20,1889, p. 66 ..... . 
42,467 
1,524 
3.6 
23 
1 
4.4 
Grisolle, Traits de la Pneumonie, Paris, 1864 
748 
183 
24.4 
Gualdi, Lancet, 1884, Vol. II, p. 27 
39 
5.1 
Hartshorn, Med. News, April 7,1888 
11.175 
1.117 
10.0 
Hegele, Kissel's Pneumonie, Eilenburg, 1852, S. 149 . 
40 
0 
0.0 
Helbing, Canstatt's Jahresb., 1850 
62 
5 
8.0 
Hellis,Ulin. m€d., Paris, 1824 
831 
173 
22.0 
Herard, L'Union m£d., 1847, No. 127 
40 
8 
20.0 
Hermann. Lungenentziindung, Munchen,1880, S.13U.42 
712 
45 
(> 
Hjaltelin, Edinb. Med. and Surg. Jour., April, 1864 . . 
80 
Q 
3 7 
Holt, N. Y. Med. Rec., Feb. 14,1885, and April 7, 1888 . 
198 
37 
19.0 
Homburger, Inaug. Dissert., Strassb., 1879, S. 71-72 . . 
Hourmann et Dechambre, Arch. g6n. de m£d., 1836 . . 
25 
9 
36.0 
109 
76 
70.0 
Hulava, Deutsch med. Zeitung, 1855 
12 
0 
0.0 
Huss, Lungenentziindung, Leipzig, 1861, S. 94 
2.710 
375 
13.9 
Jackson, N. Y. Med. Jour., March, 1875, p. 290 
51 
8 
15.0 
Jones, Jour. Am. Med. Assoc., Aug. 7, 1886, p. 144 . . . 
238 
16 
6.5 
Judrin, These de Paris, 1824, p. 17 
30 
1 
3.3 
Juergehen, Croup, Pneumonie, u. s. w., Tiib 
567 
73 
12.7 
Kiernan, Prager, Vierteljahrschr., 1867, Bd. xcix. . . 
40 
12.5 
Kierchensteiner, Aerztl. Intelligenzb., 1880 
160 
46 
28.7 
Kissel, Canstatt's Jahresb., 1852" 
112 
4.5 
Kissel, Pneumonie, Eilenberg, 1852, S. 288-91 
301 
19 
6.3 
Kocher, Pneumonie, u. s. w.. Wiirzb., 1866 : 
60 
8.3 
Kreider, N. Y. Med. Rec., Sept. 7, 1889, p. 260 
6 
2 
33.3 
Kriigerhausen, Praktische Fragmented, Coblenz, 1845! 
71 
1 
1.4 
Kiihn, Berliner k. Wochenschr., 1879, No. 37 
58 
8 
13.8 
Lacage, Ranking's Abst., No. 28, p. 92 
42 
1 
2.5 
Laennec, Diseases of the Chest, N. Y., 1830 
94 
18 
19.1 5 
Observer and Reference. 
Cases. 
Deaths 
Per 
Cent 
Laennee (A.), Jour. soc. m£d. la Loire, 1825 
40 
6 
15.0 
Laveran, Mal. des.arme£s, Paris, 1875, p. 28 
235 
46 
19.5 
Lesczinsky, quoted by Ziemssen,Pneumonie,1862,8.236 
245 
25 
10.0 
Leudet, Bull. g£n. de thgrap., 1863 . . . . 
40 
3 
7.5 
Loomis, N. Y. Med. Gaz., April 30,1881, p. 154 
255 
87 
34.0 
Louis, Rech, sur la eifets de la saigne£, Paris, 1835 . . 
78 
28 
32.2 
Louis, on Phthisis, Boston, 1840, p. 440 
18 
24.0 
MacGregor, Med. Notes on the Crimean War 
4,027 
287 
7-0 
Markham, Gulstonian Lectures. London, 1866 .... 
392 
56 
14.3 
Mason, Conn. Bd. Health Rpt., 1885, p. 338 
50 
23 
46.0 
McManus, N. Y. Med. Rec., Sept. 8,1888, p. 260 ... . 
62 
2 
3-3 
Mercier, Bull de. la soc. l'Anat., T. xii, p. 279 .... . 
70 
29 
40.1 
Mitchell, Edinb. Med. and Surg. Jour., Nov., 1857. . . 
5.909 
1,441 
24.4 
Mitchell, Ibid., p. 404 
240 
' 40 
16.6 
Montreal Gen. Hosp., Osler, Univ. MedJMag., Nov.,1888 
1,012 
207 
20.4 
Morehead, Ranking's Abst., No. 28, p. 92 . 
164 
43 
26.7 
Morris, London Lancet, N. Y„ 1881, Vol. I, p. 519 . . . 
11 
31 4 
Mueller, Ranking's Abst., No. 28, p. 92 
10 
0 
0.0 
Neumann, Berliner k. Woehensehr., 1888, S. 119. . . . 
2 
28 6 
New Orleans Hosp., Osler, Op. cit 
3,969 
1,508 
38.0 
Oppolzer, Ranking's Abst., No. 28, p. 92 
32 
5 
15.6 
Osler, Edinb. Inf. cases, Op. cit 
1,716 
306 
17.8 
Paton, Am. Jour. Med. Sci., Oct., 1870, p. 375 ... 
96 
2 
2-2 
Patton, Jour. Am. Med. Assoc., Oct. 16,1886 . . . 
63 
36 
57.1 
Pause, Lungenentziindung, Leipzig, 1861, S. 154 . . . 
169 
26 
15.3 
Peacock, St. Thomas' Hosp. Rpts.. Vol. V, p. 18 . . . 
100 
12 
12-0 
Peaslee, Chicago Med. Standard, Oct.. 1889, p. 126 . . 
29 
3 
10 o 
Pelletan, Mem. de l'Acad. de m6d„ T. VIII, p. 373 . 
11 
14.6 
Pendleburry Hosp. Repts., Manchester, 1881-86 .... 
234 
3 
1.3 
Penna. Hosp., Osler, Op. cit. . . 
704 
205 
29.1 
Pepper, Bost. Med. and Surg. Jour., April 24, 1890 . . 
1,485 
173 
11-6 
Piorry, Ranking's Abst., No. 28, p. 92 . . 
30 
2 
6^ 
Pr. Edward's Is., 1889, N. Y. Med. Rec.. July 13. '89, p 44 
546 
40 
7*3 
Prus, Mem. de l'Acad. de m&L, 1840, T. VIII, p 13 
129 
77 
59 0 
Rall, Inaug. Dissert., Stuttg., 1887, S. 5 . . . 
90 n 
Rasori, Arch. g6n. de m&L, 1824 
832 
173 
22. Q 
Reuf, Ranking's Abst., No. 28, p. 92 . 
94 
5-0 
Reyburn, Am. Jour. Med. Sci., April, 1866, p. 368 . . 
202 
14 
6.9 
Rietz, Inaug. Dissert., Jena., 1868, S. 19 
392 
50 
12 » 
Rllliet et Barthez, Mal. des enfants, Paris, 1838 
81 
77 
Robinson, London Lancet, N. Y„ 1852, Vol. II. n 288 
32 
o 
0 O 
Rodman, N. Y. Med. Rec., 1875, No. 227 . . 
98 
6 
v.y 
5 Q 
Rodman, Am. Jour. Med. Sci.. Jan., 1876 
98 
25 
M.y 
Roth, Statistik d. Pneumonie, Wiirzb., 1860 . 
237 
45 
18 9 
Routh, London Lancet, N. Y., 1855, Vol. II, p 36 
193 
9 
4 
Salawa, Schmidt's Jahrb., 1855, Bd. LXXXVI. S 30 
o 
Salem Hosp. Repts., 1877, p. 8 
2 
1 
50 0 
Sampson, London Lancet, N. Y„ 1851, Vol. II. p 36 
909 
209 
23 0 
Samter, Inaug. Dissert., Breslau, 1881 . . 
331 
39 
11 n 
Schapira, Inaug. Dissert., Wiirzb., 1877 
258 
36 
14 A 
Scheef, Inaug. Dissert., Tubingen, 1882, S. 15 
547 
72 
13 1 
Schlesinger, Inaug. Dissert., Berlin, 1873, S. 23. 24 
333 
51 
15 3 
Schmidt, Ranking's Abst., No. 28, p. 92 . 
152 
20 
13 n 
Schmidtmann, Hufeland's Jour., Bd. III. S 441 
68 
2 
10.y 
8 n 
Schroeder, Inaug. Dissert., Kiel, 1882 . 
1,277 
183 
o.y 
Schultz, Jour. Ain. Med. Assoc., July 30.1886 
238 
16 
6 5 
Scotter, Lancet, 1890, Vol. II, p. 1170 
29 
18 
62 1 
Sigmund, Ranking's Abst.. No. 28, p. 92 . 
743 
104 
14 0 
Skoda, Allgem. Weiner med. Zeitung, 1863 
555 
74 
13.3 6 
2 
Per 
Observer and Reference. 
Cases. 
c3 
Cent 
Q 
Smith, Schmidt's Jahrb., Bd. CXXXII, S. 321 
103 
3 
2.7 
Speck, Inaug. Dissert., Marb., 1870, S. 2 
50 
12 
24.4 
Steelier, Inaug. Dissert., Leipzig, 1866, S. 14 
656 
128 
19.5 
Steffan, Klinik d. Kiuderk., Berlin, 1865 
94 
13 
13.8 
Steinmetz, Ohio Med. Recorder, June, 1877, p. 34 . . . 
83 
24 
29.0 
Stephan, Neder. Weekblad, 1888 
25 
9 
36.0 
Stortz, Inaug. Dissert., Wiirzb., 1884 
1,432 
258 
18.5 
Stevens, Am. Jour. Med. Sei., Oct., 1870, p. 376 .... 
78 
5 
6.5 
Stierlin, Berliner k. Wochenschr., 1870, No. 26 ... . 
150 
7 
4.6 
Stiertin, Ranking's Abst., No. 28, p.92 
150 
4.6 
St. Mary's Hosp., Quincy, Rept., 1876 
4 
1 
25.0 
St. Michael's Hosp., Newark. Rept., 1876 
29 
4 
13.0 
Stoahml, Ranking's Abst., No. 28, p. 92 
30 
0 
0.0 
Stockholm Mil. Hosp., Huss, Op. cit., S. 86 
670 
49 
/ .3 
Strong, N. Y. Med. Rec., March 16, 1889, p. 291 .... 
20 
1 
5.0 
Sturges, Pneumonia, London, 1876 
452 
35 
7.7 
Thiele, Deutsche Klinik, 1855 
6 
0 
0.0 
Thielemann, Ranking's Abst., No. 28, p. 92 
110 
12 
11.0 
Thomas, Am. Jour. Med. Sei., Oct., 1870, p. 376 .... 
106 
3 
3.0 
Thomas, Arch. d. Heilk., Bd. IV, Heft. 2 
65 
14 
21.5 
Thomas, Richmond and Louisville Med. Jour., 1876 . 
68 
1 
1.9 
Tommasini, Delle Peripneumonie, Bologne, 1817 . . . 
115 
14 
12.1 
Townsend, Jour. Am. Med. Assoc., Dec. 1,1888, p. 789. 
42 
2 
5.0 
Townsend and Coolidge, Med. News, July, 1889 .... 
1,000 
250 
25.0 
Tregagno Epidemic, Deutsch med. Zeit., 1883, Nr. 41 . 
100 
30 
30.0 
Trousseau, Ranking's Abst., Nr. 28, p. 92 
52 
2 
4.0 
U. S. Army, 1840-59. Hartshorn, Op. cit 
2,073 
224 
10.8 
U. S. Army, Rebellion, Med. Hist., Vol. I. Pt. 1 . . . . 
77,335 
20,116 
26.1 
U. S. Army, 1870-74. Circular No. 8 
791 
110 
14.0 
U. S. Army, 1888, Rept., p. 88 
99 
26 
26.0 
17. S. Marine Hosp. Service, 15 years, Repts 
3,511 
598 
17.0 
U. S. Naval Repts., 1879-81-82-88 
171 
11 
6.4 
Valleix et Vernois, Quoted by Buchut, Dis. Chil., p. 325 
128 
127 
99.2 
Varrentrap, Henle's u. Pfeiffer's Zeitschr., 1851 . . . 
23 
1 
4.0 
Vienna Gen. Hosp., Ranking's Abst., No. 28, p. 92 . . . 
6,798 
1,966 
29.0 
Vienna Gen. Hosp., Juergensen, Ziemssen's Handb . 
7,942 
1,946 
24.7 
Voght, Bull. gen. de th^rap., Jan., 1860 
56 
4 
7.0 
Vogt, Quoted by Kocher, Op. cit., S. 28 
51 
4 
7.8 
Wagner, Contrastimulus, u. s. w., Berlin, 1819 .... 
13 
53.8 
Waller, Inaug. Dissert., Erlangen, 1877, S. 25 
81 
9 
11.1 
Wassider, Ranking's Abst., No. 28, p. 92 
112 
4 
3.5 
Waters, Liverpool and Manchester Repts., Vol. IV . . 
59 
2 
3.4 
Waters, Diseases of the Lungs, p. 87 
44 
1 
2.4 
Witherspoon, Am. Jour. Med. Sci., Oct., 1870, p. 376 . . 
72 
9 
3.0 
Witte, Inaug. Dissert., Berlin, 1877, S. 41 
505 
25 
5.0 
Wittich, Ranking's Abst., No. 28, p.92 
23 
0 
0.0 
Woman's Hosp., Phila., Rept., 1876, p. 12 
4 
0 
0.0 
Woodson, Am. Prac., Mar., 1870, p. 289 
20 
2 
10.0 
Woodward, U. S. Marine Hosp. Repts.. 1890, p. 155 . . 
13 
9 
15.0 
Wucherer, Ranking's Abst.. No. 28, p. 92 
90 
1 
1.1 
Wunderlich, Arch. f. p. Heilk.. Bd. ill. 1856 
237 
25 
10.5 
Wunderlich, Inaug. Dissert., Tub., 1858, S. 31 
50 
8 
16.0 
Zeigeli. Satterthwaite, Med. News. Jan. 5, 1889 .... 
40 
0 
0.0 
Author 
498 
81 
16.4 
Totals and average si 
223,730 
40,276 
18.1 7 
Several fallacies are liable to creep into a table of 
this kind. One of these is the fact that some obser- 
vers count, whilst others do not, those cases of pneu- 
monic inflammation occurring in the course of other 
grave disorders, e. g., diabetes, chronic nephritis, cere- 
bral disease, cancer, typhoid fever, etc. It is clear 
that if such cases are included in the calculation, 
the death-rate will be higher than when primary 
cases are alone considered. Again, many observers 
report a series of cases to illustrate the advantages of 
some favorite method of treatment. In this instance 
the reporter is prejudiced, and is prone to omit32 from 
his list as many of the cases as can possibly be elim- 
inated, in order that his percentage of cures may be 
raised. 
There are certain antecedent and surrounding cir- 
cumstances which influence favorably, or the reverse, 
the termination of the disease; e.g., age, sex, consti- 
tution, temperament, idiosyncrasies, previous health, 
habits, etc., of the patient, and these must all be con- 
sidered in forming a prognostic opinion. 
Age exercises a remarkable influence over the fatal- 
ity of pneumonic fever. Patients between the ages of 
10 and 40 years withstand the malady better than do 
those older or younger, and the nearer we approach 
the extremes of life, the greater the mortality.33 The 
death-rate in patients over 60 years of age is, accord- 
ing to some careful observers, as high as 80 per cent., 
and in the very young it is nearly as great. In the 
case of infantile pneumonic fever, there is a difference 
of opinion as to its fatality. 
Thus, Trousseau34 is said to have never lost a genu- 
ine case in a child. Sturges35 says that " the old are 
likely to die, the young to recover." D'Espine36 says 
that the danger in infants is very slight. Ziemssen37 
lost only 7 of 201-3.3 per cent.-infantile cases. Juer- 
gensen38 lost 4 of 171 cases in children under 10 
years of age-a death-rate of only 2.3 per cent. Ba- 
ginsky39 considered the danger slight. Vogel40 says 8 
that in very young children the death-rate is consid- 
erable, but " children over 2 years of age bear lobar 
pneumonia as well as adults." Steffen41 reports a 
mortality of 13.8 per cent, in children, and Funck42 
places it at 10.3 per cent. Barthez43 had but 2 deaths 
in 212 cases between the ages of 2 and 15 years-a 
mortality of 1.9 per cent. Gerhard44 lost only one of 
40 patients ranging in age from 6 to 16 years. Le- 
bert45 regards the danger very slight in patients aged 
from 5 to 30 years. Fox46 says that " childhood is a 
doubtful cause of death." Stortz47 and Schroeder48 
say that the danger is less in children than in adults, 
and this opinion is shared by Schapira,49 Franque50 
and others.51 My own infantile cases have died in 
less numbers than in the case of adults. 
The percentage of deaths at various ages52 is shown 
in the following table : 
Table II.-Showing Death Rate of Pneumonic Fever at Various 
Ages-Per Cent. 
Authority. 
-10 
10-20 20-30 3Q-4040-50 50-60 
60-70 
70+ 
Bamberger^ 
4.0 
3.2 
5.2 
7.0 
35.0 
40.0 
50.0 
Biaehai 
9.4 
13.3 
23.3 
31.6 
37.8 
54.0 
56.6 
Chomelao 
13.6 
18.0 
33.3 
40.0 
63.0 
Derpmann56 
26.3 
49.2 
48.9 
38.9 
48.1 
40.6 
11.5 
21.2 
Doubledayo? . 
21.5 
33.3 
53.3 
70.7 
66.6 
56.2 
50.0 
FranqueoS 
3.1 
10.9 
23.5 
33.3 
76.9 
Huss59 
11.1 
7.8 
7.9 
15.1 
23.7 
26.9 
38.9 
60.0 
Juergensenso 
4.0 
6.0 
10.0 
12.0 
16.0 
11.0 
Klingeroi 
43.4 
2.2 
4.3 
5.0 
7.3 
12.2 
17.8 
10.7 
L6pine62 , . . • • 
14.0 
20.0 
25.0 
30.0 
30.0 
80.0 
Pause63 
2£L5 
17.2 
10.5 
11.1 
35.7 
38.4 
RothM 
4.0 
7.6 
20.9 
26.7 
32.3 
26.7 
60.0 
Schapira65 
1.4 
2.8 
11.4 
21.7 
24.0 
50.0 
75.0 
Stectiert^ 
46.1 
6.8 
7.2 
21.1 
40.7 
52.0 
66.6 
66.6 
StortzBT 
2.4 
6.0 
10.5 
26.8 
33.3 
50.0 
50.0 
Swettcs 
24.4 
14.3 
16.6 
20.0 
25.0 
Townsend and Coolidge69 .... 
10.0 
10.6 
18.5 
25.3 
29.2 
55.0 
46.9 
66.7 
Author?!) 
8.0 
3.1 
7.0 
9.4 
13.0 
24.0 
37.0 
53.0 
Soldiers, on account of their age and surround- 
ings, and from coming early under careful treatment 
and nursing, present but a light death-rate.71 
In the German army during the years of peace- 
1868 to 1878, excepting the years 1870-71-there were 9 
42,476 cases of pneumonic fever, with 1,524 deaths, 
a rate of only 3.6 per cent. During the twenty-six 
years from 1854 to 1879, there were at the Germers- 
heim garrison 396 cases of this disease, 24 proving 
fatal, a rate of 6.6 per cent. In the Stockholm mili- 
tary hospital during the four years 1842-45, there were 
670 cases of this malady, with 49 deaths, a rate of 
7.3 per cent.72 
Pneumonic fever is much more fatal in ordinary 
hospital than in private practice.73 This is due, in a 
measure, to the fact that such cases usually come late 
under treatment, and the patients are of a class which 
bears up illy under severe illness. The jolting to 
which they are often subjected, in being transported 
to the hospital, is also very injurious.74 
Pneumonic fever is more dangerous in the female 
than in the male,75 and this in the face of the fact 
that the normal death-rate for males is slightly in 
excess of that for females in diseases of all kinds.78 
Table III.-Showing Comparative Mortality of Pneumonic Fever 
by Sexes. 
Observer. 
MALES. 
Females. 
Total. 
Cases. 
Deaths. 
0 
Cases. 
Deaths. 
£ 
Cases. 
Deaths. 
* 
Berlin Charite^ 
453 
90 
20.0 
114 
26 
23.0 
567 
116 
20.5 
Biachss 
8,247 
1,707 
20.7 
3,195 
959 
30.0 
11,442 
2,666 
24.2 
Chomel86 
313 
38 
12.5 
70 
22 
32.0 
383 
60 
15.6 
Dietls'? 
364 
28 
6.7 
297 
41 
12.1 
661 
69 
10.4 
HUSS88 
2,259 
291 
12.9 
451 
84 
18.6 
2,710 
375 
13.8 
Huss,89 Vienna Cases . . 
3,981 
831 
20.9 
2,009 
610 
30.4 
5,990 
1,441 
24.5 
Juergensen^ 
5,467 
1,149 
21.0 
2,475 
795 
31.1 
7,942 
1,944 
24.9 
Louis9i 
52 
15 
29.0 
23 
. 3 
13.3 
18 
24.0 
Munich Hospt92 .... 
794 
132 
16.6 
352 
81 
23.0 
1,146 
.113 
18.5 
Paused 
86 
14 
16.2 
83 
12 
14.4 
169 
26 
15.3 
Stecher94 
548 
95 
17.3 
108 
33 
30.6 
656 
128 
19.5 
StortzSo 
199 
23 
10.6 
87 
22 
25.3 
286 
45 
25.7 
Townsend & Coolidge96. 
724 
182 
25.0 
276 
68 
25.0 
1,000 
250 
25.0 
Wallers < 
71 
7 
10.0 
10 
2 
20.0 
81 
9 
11.1 
Author 
295 
41 
14.3 
203 
.40 
19.7 
498 
81 
16.4 
Totals and averages . 
23,853 
4,643 
19.4 
9,753 
2,798 
28.7 
33,606 
7,441 
22.1 
Franque77 found the death-rate in 1,796 cases of 
pneumonic fever, 17 per cent, for males and 23 per 10 
cent, for females. Lebert78 found the rate 16 and 21.8 
per cent, respectively. In the Munich General Hos- 
pital the rate is 16.6 and 23 per cent, respectively.79 
In the three large hospitals of Vienna, the death-rate 
in 8,247 male cases was 20.7 per cent., and in 3,195 
female cases 30 per cent.80 Bamberger81 found the 
rate in males 8.7, and in females 16.6 per cent. Roth82 
found it 16.2 and 23.6 per cent, respectively.83 
It has been supposed that this extraordinary fa- 
tality of pneumonic fever in the female is largely 
confined to the menstrual and childbearing periods 
of life,98 but the statistics of Klinger,99 Stortz,100 and 
of my own cases, render this improbable. 
The occurrence of menstruation during an attack 
of pneumonic fever has had usually, in my experi- 
ence, a beneficial influence.101 Under such circum- 
stances the fever often declines, the nervous excite- 
ment is lessened, and there is a distinct amelioration 
of all the symptoms. 
According to Chomel,102 menstruation increases the 
danger, whilst Grisolle103 says that it increases the 
severity, but not the mortality of the disease.104 
Pregnant females, according to Greene105 and oth- 
ers, are necessarily in greater danger than those who 
are not in this condition, from the fact that there is 
added to the dangers of the disease those of abortion 
or premature delivery,106 which occurs in a consider- 
able proportion of cases. 
Chomel107 considers pneumonic fever in pregnant 
females as usually fatal; the danger being due to 
the impediment to respiration and the frequent oc- 
currence of abortion. Of 39 cases analyzed by Cha- 
telain,108 abortion or premature delivery occurred in 
19, and of these 19, 10 died, and of the 39, 20 died. 
Of 43 cases analyzed by Juergensen,109 25 aborted, and 
of these 7 died.110 Of my 11 cases, 4 aborted and one 
died.111 
Post-mortem parturition may occur, as in the case 
observed by Post,112 in which a woman seven months 11 
pregnant died in the St. Louis Female Hospital in 
1872, of pneumonic fever. There were no symptoms 
of labor before death, but shortly afterwards it was 
discovered that a living child had been born, which 
soon died.113 
Pneumonic fever occurring during the puerperium 
is also extremely dangerous.114 
Inasmuch as the different races of mankind have 
various physical and mental peculiarities, it is a fair 
inference that they will be differently affected by dis- 
ease, and observation has abundantly confirmed the 
supposition in this disease. Pneumonic fever is very 
much more dangerous in the negro than in the Cau- 
casian race.115 
In estimating the mortality of any disease as it 
manifests itself in the negro of North America, it 
must be borne in mind that he has an inherent antip- 
athy to consulting a physician. If he is indisposed, 
or even seriously ill, he either disregards his com- 
plaint, or makes use of the domestic remedies sug- 
gested by some aged negress, thus remaining for days 
in the most unsuitable surroundings, without any 
medical treatment, at a time when proper measures 
might be of much avail-until the malady has pro- 
ceeded beyond the bounds of assistance. 
It is a general impression with writers, that the 
strong, the robust and the generally healthy with- 
stand attacks of pneumonic fever better than those 
of slighter build,116 the cachectic and the sickly. This 
may be true in the experience of others, but it cer- 
tainly does not accord with my own observation, and 
I have for many years looked upon cases of the dis- 
ease occurring in the robust specimens of manly vigor 
with suspicion. 
Irregular modes of living and habits of drunken- 
ness117 add greatly to the inherent danger of the 
malady.118 
Huss119 lost 20 per cent., and Fismer120 50 per cent., 
of alcoholic cases, and Greene121 estimates the death- 12 
rate of such at from 25 to 50 per cent. I am inclined 
to think that, in confirmed drunkards, it exceeds even 
these figures. 
The victim of chronic alcoholism is in such a state 
of physical and mental weakness as to be illy able to 
withstand the onslaught of any disease, and especially 
one of the gravity of pneumonic fever. He is usually 
a man having the appearance of robust health, but a 
careful scrutiny will reveal this to be a delusion and 
a snare. His bloated and rubicund visage, his pon- 
derous abdomen and his full but soft fleshy parts are 
no more the indication of strength and vigor than is 
the padding of a Punch and Judy character. His 
digestive apparatus is in a state of chronic irritation, 
and it has for so long a time been accustomed to ex- 
cessive stimulation that it no longer responds to 
ordinary irritation, and in the case of disease refuses 
longer to receive food or even the fiery draughts 
which have been the patient's ruin. The nervous 
system also weakens remarkably. 
When pneumonic fever attacks such a person it is 
prone to pursue a latent and insidious course. The 
initial chill is either absent or but slightly marked. 
The patient has, for several days, lost his appetite 
and cannot retain upon his stomach his accustomed 
ration of alcoholic liquors. He is nervous by day 
and restless by night. He feels tired and languid, 
and no longer seeks his companions at his accus- 
tomed haunts, but prefers to remain at home, and 
yet is afraid to be alone. With the access of the dis- 
ease he is at once and completely prostrated. He 
may have a cough, with expectoration and some un- 
easiness referable to the chest. The cough, if present, 
often escapes notice from the fact that these old 
topers have an habitual cough and hawking. If the 
lungs be now examined, the ordinary physical signs 
of pneumonic inflammation will be found. Delirium 
tremens is_ of very frequent occurrence, and the pa- 
tient, obtaining no sleep, together with the constant 13 
action, absence of nutrition and the ravages of the 
disease, soon falls into a state of profound depression 
and usually dies. 
The seat, extent and degree of the local inflamma- 
tion will greatly modify the prognosis.122 It is gen- 
erally considered more dangerous when the upper 
lobes are affected123 than when the lesion is basic, 
although this view does not accord with my experi- 
ence or the opinion of a few others.124 
Ruehle125 is of the opinion that when the apex is 
affected, the fever continues longer, resolution is 
delayed and recovery is not so perfect as when the 
base is inflamed. 
Auenbrugger126 considered the danger enhanced 
when the local lesion was on the left, and Chomel127 
when on the right side. In my cases the fatality has 
been greatest when the right lung was inflamed, 
but I am inclined to attribute the result to the fact 
that the average extent of pulmonary involvement 
was greatest in the right sided cases.128 The more 
extensive the local involvement, especially when both 
lungs are affected, the greater the danger.129 
Schuyler130 says that "inasmuch as the more exten- 
sive consolidations generally occur in robust subjects, 
who, as a rule, recover, and the less extensive and less 
perfectly formed processes more generally occur in 
depraved subjects in whom fatality is, as a rule, 
more frequent, therefore a greater extent of local 
process may be held as indicating a more tonic and 
resisting state of the patient, and a better prognosis, 
while a lesser extension may denote a more asthenic 
constitutional state, and hence a worse prognosis."131 
The spreading and wandering forms of the disease 
are very fatal.132 The occurrence of gangrene, ab- 
scess, general suppuration, etc., greatly increase the 
danger.133 
The duration of the disease has an important bear- 
ing upon the prognosis, and "it is often a question of 14 
the intensity of the disease on the one hand and the 
resisting powers of the individual on the other."134 If 
improvement does not occur at about the time conva- 
lescence usually begins the prognosis is rendered 
grave. 
Epidemics of pneumonic fever vary greatly in their 
fatality; in some scarcely any die and in others al- 
most every patient is doomed. The epidemic preva- 
lence of other diseases, e.g..typhoid, typhus135 or cere- 
bro-spinal 136 fever, etc., increases the severity and 
danger of pneumonic fever. 
Complications of all kinds add to the fatality of 
the disease.137 The great variety of these, together 
with their nature, seat, tendencies and surrounding 
influences renders an intelligent analysis of the in- 
creased dangers impracticable. It may be said that, 
as a rule, all anomalous features are of evil import. 
The subsequent attacks are attended by less danger 
than are the primary.138 
The death-rate of pneumonic fever varies from year 
to year,139 and month to month, the variations being 
due to accidental influences140 which either elude ob- 
servation or defy analysis. 
Briquet,141 Fox 142 and others 143 consider pneumonic 
fever more fatal during the cold than the warm 
months, but Grisolle 144 objects to this conclusion and 
it is not in accordance with my experience.145 
In fatal cases death may occur in a variety of 
ways. In some rare cases the patient is overwhelm- 
ed by the onset of the disease and dies in a few hours 
from extensive pulmonary congestion, with or with- 
out profound cerebral symptoms. In another small 
proportion of cases the morbid processes are carried 
a step beyond this. The fever rises rapidly to a high 
point, there is great respiratory oppression, and after 
perhaps but twenty-four or thirty-six hours convul- 
sions, delirium or coma ends the scene. In these 
cases the mind of the beholder is appalled by the sud- 
denness with which life was extinguished. 15 
At a later period, also, death may come on very 
swiftly, sometimes like a flash, from heart clot or car- 
diac paralysis. In general, however, when death oc- 
curs after the first days of illness, the end is ap- 
proached very gradually and with ample warning.146 
The temperature remains high, cyanosis appears and 
gradually deepens; the respiratory oppression is in- 
creased, and breathing becomes more and more diffi- 
cult and, finally, more and more shallow; the pulse 
beats with great rapidity and becomes smaller, weak- 
er, and irregular; the nose, then the hands and lastly 
the feet, ear and tongue become cold and the surface 
of the body is covered with a cold and clammy per- 
spiration ; the senses are usually benumbed147 and 
there is muscular paresis, and often slight tremor; 
the cough becomes less frequent and weaker and 
finally ceases altogether; the lower jaw is relaxed; 
the tongue, mouth and pharynx becomes dry and 
deglutition becomes difficult and finally impossible; 
the secretions are not removed from the air passages 
and a loud and ominous tracheal rattle startles and 
appalls the listener148; the respirations grow weaker 
and weaker, and with pauses of longer and longer 
duration, until at last they cease and life is a thing 
of the past. 
It has long been supposed, erroneously, I think, 
that death, when it occurs, is likely to come at the 
end of a septenary period. Thus Delafield149 in an 
analysis of 123 fatal cases found that the largest num- 
ber died on the seventh day; the next largest on the 
fourteenth day; the next largest on the twenty-first 
day, and the next largest on the twenty-eighth day. 
These remarkable coincidences probably could not be 
duplicated in any other series of cases.130 
No series of observations sufficiently extensive have 
been made as to the hour when death oftenest occurs; 
but of between 5,000 and 6,000 deaths from all causes 
Haviland151 found the greatest number to have occur- 
red between 1 and 8 o'clock a.m., and the least between 16 
1 and 12 o'clock p.m., whilst Burns152 in analyzing 
15,000 deaths came to the conclusion that death occurs 
irrespective of hours. 
Instances of sudden death during the progress of 
this disease are of comparatively frequent occurrence 
and must have been met with by almost every gener- 
al practitioner of much experience.153 Cases of this 
description, caused by heart-clot, paralysis of the 
heart and apoplexy are readily explainable, but there 
remains a certain proportion of cases in which no 
gross anatomical lesion can be found to explain the 
untoward result, and which must, with our present 
knowledge,remain with the occult mysteries of nature. 
A man aged 60, apparently in his usual health, 
went from camp to the city (three miles by train) 
one morning. At noon he was taken suddenly and 
violently ill at the house of a friend, and within two 
hours was sent to the City Hospital. The attending 
physician reported that he was received unconscious, 
cold extremities, rapid breathing, temperature 103, 
and almost moribund. He died within six hours of 
the attack. Autopsy revealed : lower right lobe pass- 
ing into a stage of gray hepatization, . . . remainder 
of lungs deeply engorged.154 
An intelligent man, aged 78, was the subject of 
chronic genito-urinary disease. He complained of 
colic at 5 p.m., and was given an enema. He contin- 
ued restless until midnight when he called for the 
commode, arose, sank back into the bed and expired. 
The autopsy revealed inflammation of the base of the 
right lung.155 
A large and well nourished man, aged 76, felt un- 
well for several days but was walking about, with a 
temperature of 99.5°; nothing wrong was discovered 
with the lungs upon examination. Next morning he 
was restless, had a temperature 100°, pulse 105, fee- 
ble, and respirations 28. Distress in epigastrium; no 
cough, but there was dullness over the lower two- 17 
thirds of the right lung, with very little air entering 
the part. An hour later he raised up, called the nurse 
and expired. The autopsy disclosed inflammation of 
nearly the whole of the right lung.156 
A female, suffering from pneumonic fever, locally 
affecting the middle lobe of the right lung, was so 
little ill on the third day that she persisted in getting 
out of bed. This she did, dressed, walked across the 
room and fell dead.157 
A man, aged 28, was "admitted with pneumonia of 
the lower lobe of the left lung. The attack was a 
slight one, and the patient improved rapidly. On the 
morning of the 16th day, as he returned from the 
bath room, he staggered and fell. He was picked up 
and put to bed, when he expired almost instantly." 
The autopsy showed the lower lobe of the left lung in 
a stade of gray hepatization. Both lungs were cede- 
matous.158 
As shown in the last case, sudden death in pneu- 
monic fever is not confined to the acute stages of the 
disease, but it may occur long after apparent conva- 
lescence has set in, and this too, irrespective of the 
character and severity of the attack. 
In the autumn of 1875, I attended a little girl of 8 
years, with a mild attack of pneumonic fever, the lo- 
cal lesion being confined to the base of the right lung. 
The disease pursued an ordinary, but mild course and 
deferverscence by crisis occurred on the fifth day. For 
a week she remained tired and weak, but improved 
daily. Her cough had almost ceased, there was no 
dyspnoea and her appetite was good. One morning, 
exactly a week after the crisis, her mother came to 
her bedside, requested her to arise and asked what 
she desired for breakfast. The child not appearing 
at the table, the mother ten or fifteen minutes later 
returned to the bed chamber to find her child dead. 
It was supposed that she had attempted to arise and 
had instantly expired.159 18 
A certain proportion of persons have hearts of very 
little stability and a trifling impediment to the heart's 
action may cause sudden alarming or fatal symptoms. 
It is this contingent which furnishes the majority of 
sudden deaths in pneumonic fever. 
In estimating the chances of recovery in this dis- 
ease the local lesions, general symptoms and the pre- 
vailing morbid influence should all be carefully con- 
sidered. The omission of this cardinal principle by 
the medical attendant may be the cause of lamenta- 
ble errors. A prognosis based upon general impress- 
ions is valuable, but a careful consideration of all 
the surrounding circumstances should not be neg- 
lected. In formulating an opinion individuality 
must always play an important part, as the progno- 
sis in any individual case will vary from the average 
from an infinity of circumstances. A 
For this reason numerical calculations musT al- 
ways occupy a secondary place in estimating the fa- 
tality of this malady when an individual case is con- 
cerned. In this field there must be considered a mul- 
titudinous array of circumstances which cannot pos- 
sibly be considered by the numerical method of cal- 
culating chances. Individual cases can only be esti- 
mated separately. If, however, we desire to estimate 
the average probable death rate we may safely invoke 
the aid of the doctrine of numerical chances, provid- 
ed, always, that in making the calculation we employ 
practically infinite numbers. 
163 State Street. 
i Restorative Treatment of Pneumonia, p. 45. 
2 See Cincinnati Lancet and Observer, November, 1862, p. 668. 
3 Rev. med. de Toulouse, July, 1879. 
4 Physician and Surgeon, April, 1876, p. 161. 
5 Am. Jour. Med. Sci., October, 1870, p. 375. 
6 Richmond and Louisville Med. Jour., April, 1876. 
7 Pleuritis u. Pneumonie, Berlin, 1862, S. 256. 
8 London Practitioner, Vol. xxxi, p. 39. 
9 Clinical Medicine, Phila., 1873, Vol. i, p. 663. 
io Pneumonie u. Pleuritis, Wiirzb., 1880, S. 3 und 66. 
u N. Y. Med. Record, July 14,1877. 
12 Contributions to Clinical and Practical Medicine, London, 1887. 
is See Barnett, Jour. Am. Med. Assoc., December 11,1886, p. 656: Mor 19 
row, Prac. Med., Columbus, 1853, p. 706; Rindfleisch, Path. Histol., Phila., 
1872,p. 391; et al. 
14 N. Y. Med. Record, September 17,1887, p. 375. 
15 Medical News, April 7,1888. 
16 Prac. Medicine, Phila., 1847, Vol. xi, p. 41. 
17 See Chaumier, Gaz. des H6p., 1884; Cobleigh, Phila. Med. World, 
April, 1885, p. 132; Donaldson, N. Y. Med. Jour., March 7,1885, p. 267; Grim- 
shaw, Dublin Jour. Med. Sci., May, 1875; Holt, N. Y. Med. Record, Febru- 
ary 14, 1885, p. 174; Legendre, Arch. gen. de med., 1859: Rodman, N. Y. 
Med. Record, 1875; Stratton, Med. Brief, May, 1886, p. 205; Whittaker. Gin. 
Clinic, June 16,1877; et al. • 
18 Am. Jour. Med. Sci., Vol. xiv, p. 328. 
19 Smith, Guy's Hosp. Rep., Vol. xliv, p. 59; et al. 
20 Med. Die., N. Y., 1855, Vol. xi, p. 892. 
21 Dis. Int. Valley N. A., Phila., 1854, p. 853. 
22 Medical Sketches, Dedham, 1815. 
23 See Andral, Path. Med., Paris, 1836, T. 1, p. 386; Cowan, Trans. Tenn. 
State Med. Soc., 1891, p. 195; Gairdner, Lancet, 1887, Vol. ii, p.247: Golynz, 
Trudi Russk. Obsh. ochran. narod-zdravija, St. Peter sb., 1890, vi, p. 140: 
Loubimoff, Protokol. Zasaid. Kavkazsk. med. Obsh., Tiflis, 1889-90, xxvi, 
p. 444; Patten, Therap. Gaz., April, 1885, p. 234: Robb, Jour. Am. Med. 
Assoc., November 28,1885, p. 614; Routh, London Lancet, N. Y., 1855, Vol. 
ii, p. 145; Steinmetz, Ohio Med. Record, June, 1877, p. 34; Woodson, 
Trans. Tenn. State Med. Soc., 1891, p. 193; et al. 
24 Med. News, June 9, 1883, p. 646. 
25 Pepper's Syst. Med., Phila., 1885, Vol. iii. 
25 Lancet, 1891, Vol. i, p. 647. 
26 Op. cit., p. 267. 
27 Jour. Am. Med Assoc., October, 1885. 
28 Natural History of Pneumonia, London, 1876, p. 203. 
2'J Op. cit. 
30 Smith, N. Y. Med. Rec., October 20,1888, p. 469: Woodson, op. cit., p 
193; et al. 
31 No attempt has been made to render this table complete. 
32 See also Gairdner, Dublin Med. Press, February 28,1855. 
33 See also Aitken, Sci. and Prac. Med., Vol. ii, p. 74; Bamberger, 
Wiener Med. Wochenschr., 1857, Nr. 50 u. 51; Biach, Med. Jahrb., Wien., 
1879: Chomel, Pneumonie, Leipzig, 1841, S. 304; D'Espine, Ann. d'hyg. et 
de med., 1840, T. xxiii, p. 50; Doubleday, N. Y. Med. Rec., March 28,1885. 
p. 343: Forscheimer, Cincinnati Lan. and Clinic, January 28,1882: Fox, 
Op. cit., p. 205: Franque, Statistik d. Pneumonie, Wiirzb.,'1855; Grisolle, 
Traite de la pneumonie, Paris, 1864; Hourmann et Dechambre, Arch. gen. 
de med., T. xii, p. 28, Huss, Op. cit., S. 94; Juergensen, Ziemssen's Handb., 
Bd. v: Lebert, Berliner k. Wochenschr,, September 4,1871; Lees, Lancet, 
1889, Vol. ii, p. 890; Lepine, Pneumonie, Wien., 1883, 8.159; Loomis, Pep- 
per's Syst. Med., Phila., 1885, Vol. iii, p. 195; Niemeyer, Prac. Med., Vol. 
1, p. 183; Porter, St. Louis Med. Press, March 30, 1889, p. 340; Rilliet et 
Barthez, Mal de 1'enf., Paris, 1838; Robb, Op. cit., p. 614; Routh, Op. cit., 
p. 145; Sehapira, Inaug. Dissert., Wiirzb., 1877; Schroeder, Inaug. Dissert., 
Kiel., 1882: Smith, Guy's Hosp. Repts., Vol. xliv, p. 59: Speck, Inaug. 
Dissert., Marb., 1870, S. 4; Sturges, Op. cit., p. 203; Swett, Dis. Chest, N. 
Y., 1856, p. 86; Ziemssen, Op. cit.; et al. Schuyler, N. Y. Med. Jour.,May 
14, 1887, p. 543, says that " age in itself is not a cause of death in acute lobar 
pneumonia." 
34 Med. Klin., iibersetz, von Ciilmann, Bd. 11, S. 410. 
35 Op. cit., p. 203. 
so Trans. Intern. Med. Cong., Washington, 1887. 
37 Pleuritis u. Pneumonie, Berlin, 1862, S. 256. 
38 Ziemssen's Handb. d. Spec. Path. u. Therap., Bd. v, 1877, S. 158. 
39 Pneumonie u. Pleuritis, Wiirzb., 1880, S. 66. 
40 Diseases of Children, Am. Ed., p. 294. 
41 Klinik d. Kinderkrankh., Berhn(H865. 
42 Inaug. Dissert., Griefsw., 1868. 
43 Bull, de l'Acad. de med., 1863, T. xxvii, p. 676, 
44 Am. Jour. Med. Sci., Vol. xiv. 20 
45 Berliner k. Wochenschr., September 4,1871. 
<6 Op. cit., p. 209. 
47 Inaug. Dissert., Wiirzb., 1884, S. 40. 
48 Inaug. Dissert., Kiel, 1882. 
« Inaug. Dissert., Wiirzb., 1877, S. 19. 
50 Op. cit., Diss 
51 Rufz, Jour, de med. et de chir., T. iii, p. 101; et al. Snow, N. Y- 
Med. Rec., June 15,1889, p. 652, considers the danger increased by the 
presence of rickets. 
52 See also Loomis, Frac. Med., N. Y., 1884, p. 95; Schuyler, N. Y. Med. 
Jour., May 14,1887, p. 543; et al. 
53 Wiener med. Wochenschr., 1857. 
54 Op. cit. 
55 Pneumonie, Leipzig, 1841, p. 304. 
56 Inaug. Dissert., Bonn, 1885, S. 19. 
57 N. Y. Med. Rec., March 28, 1885, p. 343. 
58 Statistlk d. Pneumonie, u. S. W., Wiirzb., 1855. 
59 Lungenentziindung, Leipzig, 1861, S. 94. 
60 Op. cit. 
61 Bayer, arztl. Intelligenzbl., 1874, Nr. 35 u. 36. 
62 Pneumonie, Wien., 1883, S. 159. 
63 Lungenentziindung, Leipzig, 1861, S. 154. 
64 Inaug. Dissert., Wiirzb., 1860. 
65 Inaug. Dissert., Wiirzb., 1877. 
66 Inaug. Dissert., Leipzig, 1866, S. 14. 
67 Inaug. Dissert., Wiirzb., 1884, S. 19. 
68 Diseases of the Chest, N. Y., 1856, p. 86. 
«9 Trans. Am. Clinical Assoc., 1889. 
70 Medical Progress, February, 1890, p. 637. 
71 See Colin, Etudes clin. de med. mil., Paris, 1863; Hermann, Lungen- 
entziindung, Miinehen, 1880, S. 6; et al. 
72 See Huss, Op. cit., S. 87. 
73 See Lebert, Berliner k. Wochenschr., Sept. 4. 1871; et al. 
74 See Wells, Jour. Am. Med. Assoc., Dec. 19,1885. 
75 Bamberger, Wiener, m. Woch., 1857; Chatelain, Jour, de med. de- 
Brux., 1870; Chomel, Op. cit., S. 305; Fox, Op. cit., p. 205; Franque, Inaug. 
Dissert, Wiirzb., 1855; Funck, Inaug. Dissert., Griefsw., 1868; Green, 
Oubeur, Die. Med. N. Y. 1884, p. 881; Huss, Op. cit., S. 71; Lebert, Klinik. 
d. Brustk. Tub., 1873; Lepine, Pneumonie, Wien, 1883, S. 160; Pause, Lun- 
genentziindung, S. 126; Robb, Jour. Am. Med. Assoc., Nov. 28,1885, p. 614; 
Routh, Lon. Lancet, N. Y., 1855, Vol. xi, p. 145: Schapira, Inaug. Dissert., 
Wiirzb., 1877, S. 16; Stortz. Inaug. Dissert. S. 39; Swett, Dis. Chest. N. Y., 
1856, p. 87; Waller, Inaug. Dissert. Erlangen, 1877, S. 25; Walshe, Dis„ 
Lungs, Phila. 1860, p. 214; et al. 
76-Table I, Notes.-Showing Death Rate from all Causes by 
Sexes in Massachusetts. 
Year. 
Males 
Per 1,000. 
Females 
Per 1,000. 
Excess of 
Males over Fe- 
males per 1,000, 
1860 
19.3 
18.4 
.9 
1865 
21.7 
19.6 
2.1 
1870 
19.5 
18.6 
.9 
1875 
21.8 
20,5 
1.3 
1880 
20.3 
19.3 
1.0 
Averages 
20.5 
19.3 
1.2 
77 Op. cit. 
78 Kiinik d. Brustkrankh., Tub., 1873. 
79 Stortz, Op. cit., S. 7. 21 
so Biach, Med. Jahrb., Wien, 1879. 
si Wiener med. Woehenschr., 1857. 
82 Op. cit. 
83 Klinger, Lungenkrankh. in Bayern, 1872, found the deaths in males 
more numerous than in females. 
si Annalen, 1874-75. 
85 Med. Jahrb., Wien, 1879. 
so Lungenentziindung, S. 305. 
87 Lungenentziindung, Wien, 1853, S. 37. 
88 Lungenentziindung, S. 91. 
89 Op. cit., 8. 91. 
90 Ziemssen's Handb., Bd. V. 
91 Phthisis, Boston, 1836, p. 440. 
92 Berichte, 1865-75. 
93 Op. cit., 8. 154. 
94 Inaug. Dissert., S. 14. 
95 Inaug. Dissert., Wiirzb., 1884. 
»o Trans. Am. Climat. Assoc., 1889. 
97 Inaug. Dissert., Erlangen, 1877. 
98 See Huss, Op. cit., S. 95. 
99 Pneumonie in Bayern, Munchen, 1872. 
wo Inaug. Dissert., Wiirzb., 1884. 
ioi See also Wunderlich, Spec. Bath. u. Therap., Stuttg., 1858. 
102 Pneumonia, Leipzig, 1841, S. 306. 
103 Traite de la pneumonie, Paris, 1864. 
104 See also Fox, Reynolds' Syst.Med., Phila., 1880, Vol. II, p.205; Huss, 
Lungenentziindung, Leipzig, 1861; et al. 
105 Quain's Die. Med., N. Y., 1884, p. 881. 
106 Chatelain, Jour, de med. de Brux., 1870; Fox, Op. cit., p. 205; Guss- 
erow, Berliner k. Woehenschr., 1880, Nr. 17; Huss, Op. cit.; Juergensen, 
Ziemssen's Handb., Leipzig, 1877, Bd. V, S. 127; Grisoile, Op. cit. p. 470; 
Lepine, Pneumonie, Wien, 1883, 8. 188; Binge, Volkmann's k. Vortrage, 
Nr. 174; Robb, Jour. Am. Med. Assoc., Nov. 28, 1885, p. 614; Wells, Ibid., 
Dec. 19,1886; et al. 
107 Op. cit., 8. 307. 
108 He thinks that during the last three months 50 per cent. die. See 
Jour, de med. et de chir. de Brux, 1870, Juine. 
109 Op. cit., S. 28. 
no Op. cit., S. 127. 
in For further information consult Carroll, Cincin. Lan and Obsr., 
Aug. 1862, p. 475; Da Costa, Jour. Am. Med. Asso., Dec. 17, 1887, p. 791; 
Fisher, N.Y. Med. Rec., July 28, 1888, p. 93; Folkmann, Inaug. Dissert., 
Erlanger, 1877, S. 35; Gehrung, Am. Prac., Aug. 1877, p. 74; Harrison, Jour. 
Am. Med. Assoc., Aug. 13, 1887, p. 210; Heygate, Lancet, 1887, Vol. xi, p. 
1252; Kemper, Med. World, 1888, p. 261; Korotkevich, Russkaya Med.; 
McManus, N. Y. Med. Rec., Sept. 8. 1888, p. 260; Pause, Lungerientziind- 
ung, Leipzig, 1861, 8. 84; Polk, N. Y. Med. Jour. Sept. 15,1888, p. 284; Rall, 
Inaug. Dissert. Erlangen, 1887, S. 34: Richardson, Cin. Lan and Observ. 
Oct. 1862, p. 591: Schapira, Inaug. Dissert., S. 19; Stechert, Inaug. Dissert., 
Leipzig, 1866, S. 28; et al. 
H2 Jour. Am. Med. Assoc., Oct. 29,1887, p. 566. 
ns Coles, Ibid., p. 566. 
in Barnes, Obst. Trans., Vol. iv, p. 55; Chomel, Op. cit. S. 307; Der- 
ville, Pleuro-pneumonie dans la Fievre puerperale, Paris, 1874; Fox, Op. 
cit. p. 205; Kreider, N. Y. Med. Rec., Sept. 7, 1889, p. 260; Pause, Op. cit., S. 
85. 
115 See Armstrong, U. 8. Marine Hospt. Rpts., 1886, p. 123; Banjou, 
Mal. de Cayenne, T. 1, p. 73; Cartwright, N. O. Med. Jour., Vol. lx, p. 205; 
Daniell, Med. Topog. Guinea, p. 95: Drake, Dis. Int. Valley N. A., Phila., 
1854, p. 416; Grier, N. O. Med. Jour., Vol. ix, p. 430: Harris, Trans. Am. 
Med. Assoc., Vol. v, p. 373: Jackson, Sketches, Vol. xi, p. 84; Lewis, N, O, 
Med. and Surg. Jour., Vol. iv, p. 33: La Roche, Pneumonia, Phila., 1854 
p. 416; Pendleton, Southern Med. and Surg. Jour., 1849; Robb. Jour. Am 
Med. Assoc., Nov. 28, 1885, p. 614; Valleix, Guide du med. prat. T. 11, p 
259; et al. 22 
116 gee Fox, Op. cit. p. 206; Huss, Op. eit.: et al, 
117 Has no influence ! Owen, N. Y. Med. Rec., Aug. 18,1888, p. 185. 
118 See Copland, Med. Die., N. Y., 1855, Vol. 1; Drummond, Lancet, 1891, 
Vol. 1, p. 647; Dusol, These de Paris, 1876; Fismer, Arch. f. k. Med., Bd. 
xi, 1873, S. 391; Flint, Prac. Med. Phila., 1868, p. 184; Foramel, Cin. Lan. and 
Clinic, Jan. 15, 1887, p. 86; Fox, Op. cit., p. 207; Gerhard, Dis. Chest, Phil., 
1860, p. 202; Green, Quain's Die. Med., p. 881; Huss, Op. eit., S. 139; Lepine, 
Op. cit., S. 160; Loomis, Pepper's Syst. Med., Phila., 1885, Vol. iii; Peters, 
N. Y. Jour. Med., Vol. iii, p. 335; Robb, Op. cit., p. 614; Smith, Guy's Hospt. 
Rpts., Vol.xliv, p. 59; Swett, Dis. Chest. N. Y., 1856, p. 87: Sturges. Pneu- 
monia, London, 1876, p. 87: Watson, Prac. Phys., Phila., 1845, p. 584; et al. 
119 Op. cit., S. 139. 
120 Op. cit., S. 191. 
121 Op. cit., p. 881. 
122 Gerhard, Dis. Chest, Phila., 1860, p. 211, and Ziemssen, Pleuritis u. 
Pneumonie, Berlin 1862, S. 261, think that the seat and extent of the local 
affection exert no influence over the course of the disease. 
123 Andral, Med. Clin., Phila., 1843, Vol. ii, page 205; Chomel, Op. cit., 
p. 296; Davis, N.W.Med. Jour., Vol. iii, p.429; Fox, Reynold's Syst. Med., 
Phila., 1880, Vol. ii, p. 206; Green, Qtiain's Die. Med., N. Y., 1884, p. 880; 
Krupp, in Chomel's Pneumonie, S. 25; Louis, Roch, sur effets de la saig- 
nee, p. 42; Robb, Jour. Am. Med. Assoc., Nov. 28,1885, p. 614; Rilliet et 
Barthez, Mal. de la enf.; Scheef, Inaug. Dissert., Tub., 1882, S. 26; Schuy- 
ler, N. Y. Med. Jour., May 14,1887, p. 541; Todd, Brit. Med. Assoc. Jour., 
May 15,1852, p. 483; Watson, Prac. Phys., Phila., 1845, p. 583; et. al. 
124 Collective Invest. Rec., London, 1884, Vol. ii; Gerhard, Op. cit.; 
Ziemssen, Op. cit., S. 211. 
125 Zlemssen's Handb., Leipzig, 1877, Bd. V. Heft 2, S. 28. 
126 Inventum Novum, etc., Vien., 1761, sec. xxv. 
127 Op. cit. S. 296. See also Huss, Lungenentziindung, 1862. 
128 in Townsend and Coolidge's Trans. Am. Climat. Assoc., 1889, cases 
the fatality was, according to the seat of the inflammation, as follows: 
Right lung, entire, 74 cases, 39 fatal, 530; right lung, lower lobe, 377 cases, 
47 fatal, 14%; right lung, middle lobe, 19 cases, 4 fatal, 220; right lung, 
upper, 105 cases, 25 fatal, 240: Total 575 cases, 115 fatal, 200. Left lung, 
entire, 39 cases, 26 fatal, 670; left lung, lower lobe, 216 cases, 28 fatal, 
130; left lung, upper lobe, 31 cases, 7 fatal, 230; total 286 cases, 61 fatal, 
21.40. Duplex 111 cases, 63 fatal, 570. 
129 Chomel, Op. cit., S. 295; Fox, Op. cit., p. 206; Green, Op. cit., p. 881; 
Huss, Op. cit., S. 114; Martyn, London Lancet, N. Y„ 1854, Vol. i, p. 533; 
Robb, Op. cit., p. 614; Smith, Guy's Hosplt. Repts. Vol. xliv, p. 59; Todd, 
Op. cit., p. 483; et al. 
130 N. Y. Med. Jour., May 14, 1887, p. 541. 
131 These premises are opposed to my experience. 
132 Drummond, Lancet, 1891, Vol. 1, p. 647; Fox, Op. cit., p. 206 ; Green, 
Op. cit., p. 88; Lupine, Op. cit., S. 18 u. 158; Pause, Lungenentziindung, 
Leipzig, 1861, S. 9 ; et al. 
133 See especially Chomel, Op. cit., S. 297; Huss, Op. cit. 
134 Green, Op. cit., p. 882. 
135 See Caton, Lancet, 1884, Vol. 11., p. 136. 
136 Ruenberg, Berliner, k. Wochenschr., 1888, S. 94; et al. 
137 See Bennett, Restorative Treatment Pneumonia; Besnier, Thgse de 
Paris; Biach, Op. cit.; Brandes, Virchow's Archiv. bd. xv., S. 210; Dou- 
bleday, N. Y. Med. Rec., Mar. 28,1885, p. 343; Dusol, These de Paris, 1876; 
Flint, Med. News, Nov. 28,1885, p. 605; Glasgow, St. Louis Cour, of Med., 
Mar. 1886, p.195; Hartshorn, Med. News, Apr. 8, 1888; Huss, Op. cit.; 
Huxham, Bpidem. Dis. London, 1748,p.59; Juergensen, Op. cit.,; Lepine, 
Op. cit., S. 166; Moore, N. Y. Med. Rec.. July 10, 1886, p. 57; Lawrence, 
London Lancet, N. Y., 1853, Vol. 1, p. 73; Hyde, Med. News, Nov. 28, 1885, 
p. 605; Moxon, Lancet, 1884, Vol. 1, p. 53; Rilliet et Barthez, Op. cit.,; 
Robb, Op. cit., p. 614; Sturges, Op. cit.; Swett, p. 87; Van Bibber, Jour. 
Am. Med. Assoc., July 28. 1888, p. 110; Ziemssen, Op. cit., S. 261 
138 See Landsberger, Inaug. Dissert, Berlin, 1887, S. 16; Lepine, Op. 
eit.; Leudet, Jour. med.del hotel Dieude Rouen; Stortz,Inaug.Dissert., 
Wurzb., 1884, S. 51; et al. 23 
139 See Huss, Op. cit., S. 80. 
ho Glasgow, Op. cit., p. 195. 
hi Arch. gen. de med. 1840. 
H2 Op. cit., p,206. 
H3 gee Besnier, Op. cit.; Huss, Op. cit.,; Sestier, Chomel's Pneumonie, 
Leipzig, 1841; Stortz, Inaug. Dissert., Wiirzb,, 1884. 
in ()p. cit. 
H5 See also Reitz, Inaug. Dissert., Jena., 1868, S. 8. 
He The earliest, and, therefore, the most valuable sign of approaching 
death is an up and down movement of the trachea-anticipating alarm- 
ing changes in the pulse and temperature. It is due to paresis of the in- 
fra-laryngeal nerve, and sounds the first note of alarm that the central 
nervous system is profoundly and irretrievably affected. See also 
Shrady, N. Y. Med. Rec., 1875, No. 230. 
147 There are exceptions to this rule. 
hs it seems that this is unnoticed by the patient himself. 
H9 N. Y. Med. Jour. Vol. xxvii, p. 68. 
no See also Cleghorn, Op. cit., S. 243; Dietl, Op. cit., S. 72; Doubleday, 
Op. cit. p. 343; Green,Op. cit., p. 878; Hermann, Op. cit., S. 22; Pause, Op. 
cit., S. 155; Rept. Bd. Health, D. C.; 1878, p. 113; Stecher, Op. cit., S.24; 
Stortz, Op. cit., S. 57; Sturges, Op. cit., p. 272; Swett, Op. cit., p. 85; Town- 
send and Coolidge, Op. cit.; Wunderlich, Inaug. Dissert., Tub., 1858, S. 25; 
et al. 
151 London Lancet, N. Y., 1864, Vol. xi, p. 616 ; See also Berens, Phil. 
Med. Times, Apr. 3, 1875. 
152 Burns, N. Y. Med. Jour., Jan. 4, 1890, p. 17. 
153 See also Ashton. London Lancet, N. Y., 1855, Vol. 1, p. 260: Green, 
Op. cit., p. 878; Quain, London Lancet, N. Y., 1855, Vol. 1, p. 260. 
151 Patton, Jour. Am. Med. Assoc., Oct. 16, 1886, p. 427. 
155 Patton, Op. cit. 
156 Patton, Op. cit. 
157 Ewens, Lancet, 1890, Vol xi, p. 662. 
158 C. S. Marine Hospt. Repts. 1883, p. 242. 
159 See for other cases Biggs, N. Y. Med Rec. July 21, 1888, p. 77; Cru- 
viellier, Path. Anat. Liv. xxix; Fox, Op. cit. p. 183; Heale, London Lan- 
cet, N. Y„ 1853, Vol. 1, p. 64; Lesser, Berliner k. Wochenschr., 1888, S. 305: 
Maschka, Ibid, S. 305; et al.