During the past winter inflammation of the lungs has destroyed the
lives of many persons who, although they were in most cases past the
meridian of life, yet still apparently enjoyed vigorous health, and, I
have little doubt, would still have been alive and well had the
preventive means here laid down against the occurrence of the disease
from which they perished been effectively practiced at the proper
time.
The most important anatomical change occurring during the progress of
pneumonia is the solidification of a larger or smaller part of one or
both lungs by the deposit in the terminal bronchial tubes and in the
air cells of a substance by which the spongy lungs are rendered as
solid and heavy as a piece of liver. The access of the respired air to
the solidified part being totally prevented, life is inevitably
destroyed if a sufficiently large portion of the lungs be invaded.
This deposit succeeds the first or congestive stage, and it occurs
with great rapidity; an entire lobe of the lung may be rendered
perfectly solid by the exudation from the blood of fully two pounds of
solid matter in the short space of twelve hours or even less. The
rapidity with which the lungs become solidified amply accounts for the
promptly fatal results that often attend attacks of acute pneumonia.
If recovery takes place, the foreign matter by which the lung tissue
has been solidified is perfectly absorbed and the diseased portion is
found to be quite uninjured. The only natural method by which the
blood can be freed from the presence of foreign matter is by the
oxidation--the burning--of such impure matters; the results being
carbonic acid gas that escapes by the lungs and certain materials that
are eliminated chiefly by the kidneys. But when these blood impurities
exist in the vital fluid in unusually large quantities, or if the
respiratory capacity be inadequate, the natural internal crematory
operations are a partial failure. But nature will not tolerate the
presence of such impurities in the vital fluid; if they cannot be
eliminated by natural means they must by unnatural means; therefore
such material is very frequently deposited in various parts of the
body, the point of deposit being often determined by some local
disturbance or irritation.
For instance, if a person whose blood is in fairly good condition
takes a cold that settles on his lungs, he either recovers of it
spontaneously or is readily cured by means of some cough mixture; but
if his blood be loaded with tubercular matter, the latter is extremely
liable to be deposited in his lungs; the cough that was excited in the
first place by a simple cold becomes worse and persistent, in a few
months his lungs show signs of disorganization, and he has consumption
of the acute or chronic type, as the case may be.
On the other hand, if the impure matter by which the blood is loaded
be of the kind that causes the pulmonary solidifications of pneumonia,
the latter disease is very likely to be developed if a cold on the
lungs be caught.
The liability of any individual to attacks of acute pneumonia is
therefore determined very largely by the presence or absence in his
blood of the matter already alluded to. If his blood be free from it,
no cold, however severe, is competent to originate the disease.
There can be no question but that good living and sedentary habits
have a strong tendency to befoul the blood; the former renders
effective respiration all the more necessary for the removal from the
blood of whatever nutritive matter has been taken beyond the needs of
the system, and the latter inevitably diminishes the respiratory
motions to the lowest point consistent with physical comfort. From
these conditions originates the active predisposing cause of
pneumonia, to which we have already alluded.
The disease is more fatal in the very young and in the aged; the
mortality seems to bear a direct ratio to the respiratory capacity; in
young subjects the breathing powers have not been fully developed like
the other physical capacities, while in the old the respiratory volume
has been diminished by the stiffening of the chest walls and of the
lungs by the senile changes already detailed.
There can be no question but that protection from cold and judicious
attention to the health generally, by suitable exercise and diet, has
a powerful tendency to prevent that overloaded condition of the blood
to which I believe acute pneumonia to be chiefly due; still I have no
doubt but that the most active preventive measure that can be adopted
is keeping up the respiratory capacity to the full requirements of the
system, a precaution which is specially necessary to ease-loving and
high-living gentlemen who are past the prime of life. I am of the
opinion that if such persons would cultivate their breathing powers by
the simple means here recommended, their liability to pneumonia would
be notably reduced.