A Septic and Unusual Form of Lung Dis- 
ease Existing in the Mississippi Valley 
During the Years 1886-7-8-9-90. 
BY U 
WILLIAM CARR GLASGOW, M. D., 
Adjunct Professor of the Theory and Practice of Medicine in the St. Louis Medical College; 
Professor of the Diseases of the Chest and Throat in the Post-Graduate School of Medicine. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
March, 1890. Extracted from the 
American Journal of the Medical Sciences for March, 1890. 
A SEPTIC AND UNUSUAL FORM OF LUNG DISEASE EXISTING 
IN THE MISSISSIPPI VALLEY DURING THE YEARS 
1886, 1887, 1888, 1889, 1890.1 
By William Carr Glasgow, M.D., 
ADJUNCT PROCESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE ST. LOUIS MEDICAL COLLEGE: 
PROFESSOR OF THE DISEASES OF THE CHEST AND THROAT IN THE POST-GRADUATE SCHOOL OF MEDICINE. 
During the past three years an unusual form of lung disease has 
existed in the city of St. Louis and in many parts of the Mississippi 
Valley. In some cases it bears a striking resemblance to croupous 
pneumonia, although dissimilar in many of the symptoms and physical 
signs; in others the signs and symptoms would point to broncho-pneu- 
monia ; and in still others the diagnosis bronchitis would be made by a 
superficial observer. 
The great prevalence of acute pulmonary disease and the increased ratio 
of mortality during the years 1886, 1837, and 1888 are shown clearly by 
the records of the Board of Health and of the City Hospital. Through 
the courtesy of Health Commissioner Dudley, I can present a tabulated 
statement of the number of deaths, and the ratio of deaths from acute 
pulmonary disease to that of the general mortality that occurred in the 
city during the winter months of 1886, 1887, and 1888. From these 
tables we see the great increase of mortality, both in the number of cases 
and the increased ratio to the general death-rate, from the winters of 
1885 and 1886 to those of 1887 and 1888. In January and February 
of 1886 we find two hundred and nineteen deaths, which is about nine 
and one-half per cent, of the total mortality; in January and February 
of 1887 we find two hundred and fifty deaths, about ten per cent, of the 
total mortality; and in January and February of 1888 three hundred 
and eighty-three deaths, about equal to sixteen per cent, of all deaths 
reported. 
The records of the City Hospital, obtained through the politeness of 
Dr. H. N. Dalton, Superintendent, show the number of cases and the 
death-rate of the so-called pneumonias during the years of 1885 and 
1886 as one hundred and thirty-five cases and thirty-nine deaths; 1886 
and 1887, one hundred and thirty-six cases, fifty-four deaths; 1887 
and 1888, ten months, fifty-four cases, twenty-five deaths. Dr. Dorsett 
1 Read before the Medico-Chirurgical Society of St. Louis, 7, 1890. ( 2 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
of the Female Hospital, reports a death-rate of five cases out of eleven. 
From these figures we will see the increase in the number of cases and 
the death-rate to be especially great in the winters of 1887 and 1888. 
In 1887 the unusual and unexpected mortality of cases which I had 
classed as croupous pneumonia directed my attention to the subject, and 
I began to investigate this class of cases. Since that time I have seen 
one hundred and ninety-four cases, and from them I have obtained 
twenty-nine post-mortems. The greater number of these cases have 
been seen in the City Hospital, and in the St. Louis Mullanphy Hospital, 
and the post-mortem examinations have been made almost exclusively 
at the City Hospital by the internes of that institution. 
In the earlier investigation, when the clinical signs and symptoms of 
the disease were still unsettled and undetermined, twelve of these post- 
mortems showed the ordinary pathological changes of pneumonia, croupal 
or lobular, and tuberculosis, whilst seventeen alone gave pathological 
evidence of an unusual form of disease. In all of these seventeen cases 
the pathological appearances corresponded in a striking manner, and 
varying only in a degree that would correspond with differences in the 
intensity of the disease. Tli'e difference in the macroscopieal appearance 
of the organs from that seen in the ordinary forms of pneumonia 
—croupous, lobular, and embolic—was very apparent. 
Post-mortem examination showed in all cases that the greater part of 
both lungs was in a condition of infiltration by a morbid material, and 
certain limited portions were in a consolidated condition. In the least 
infiltrated parts the lung was of a black-brown color ; on pressure a firm, 
sodden feeling was given to the fingers, the normal pulmonary elasticity 
was wanting, still it crepitated with resistance, and when placed in 
water did not sink. In other parts of the lung the color was of a 
dark brown, the lung crepitated slightly, and on pressure gave a firm, 
resistant feeling not unlike a piece of beef; it would not sink in water. 
In still other parts the color of the lung was of a light brown, being 
in many cases of a steel gray; here the parts affected were absolutely 
solid, no crepitation on pressure, and the piece would sink instantly 
when placed in water. In all cases the greater portion of both lungs 
was of a dark or dark brown color, whilst the light brown or grayish 
color was found in isolated parts. The consolidation occurred in irreg- 
ular areas in the middle or lower border of the upper lobe. The apex 
was frequently found consolidated, and in three cases was converted 
into a solid mass presenting a light gray appearance. These areas of 
consolidation were always found in each lung, varying from the size of 
a walnut to that involving the greater part of a lobe. The areas were 
irregular in shape and presented no strictly defined limit such as we see 
in croupous pneumonia. The inferior part of the left upper lobe posteriorly 
was the most frequent site of the consolidation. GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
In all cases the liver was enlarged and softened; the spleen was of a 
light brown color, not much enlarged, but the substance was almost 
always softened. In two cases it was so pulpy that it could be taken 
out with a spoon. The heart was often softened, and in some cases 
could be torn easily ; in three cases it was tightly contracted in systole. 
The kidney showed pathological changes ; they were usually congested, 
and many were in a condition of parenchymatous nephritis. The venous 
system was invariably engorged with blood. This was especially seen in 
the portal system. The absence of serous effusion in the cavities, which 
should be expected from the condition of the venous system, was notice- 
able in a certain number of cases. In three cases a purulent effusion 
was found in the pleura, and in one a purulent pericarditis. Numerous 
microscopic examinations of these lungs have been made by Dr. E. M. 
Sensenv, and he reports : 
In the darkest portions, which swim in water, and where crepitation 
can be felt, the alveolar walls are seen infiltrated with leucocytes, the 
alveolae themselves remaining free. In the dark brown parts, which 
crepitate sluggishly, and which swim in water, besides infiltration of the 
alveolar walls, he finds a partial filling of the alveolae with leucocytes, 
white blood-corpuscles, epithelial debris, and occasionally some red blood- 
corpuscles. These cling to the walls of the alveolae, leaving the centre 
more or less open. In the lighter portions, which do not crepitate and 
which sink instantly in water, he finds an infiltration of the alveolar 
walls and a complete filling of the alveola. The pathological condition 
of the lung corresponds to that described as existing in broncho-pneu- 
monia. 
Clinically the diseases may be divided into what may be called the 
parenchymatous and the bronchial type of cases—the parenchymatous 
where the areas of consolidation are extensive and rapidly developed, 
and where the symptoms show the greatest intensity of the disease; the 
bronchial type where areas of consolidation are wanting or limited, and 
where the disease hardly passes beyond what may be called the first and 
second degrees. In these cases the symptoms are essentially different 
from those seen in the former, and were in some cases of so trivial a 
nature that the lung disease would have been overlooked unless atten- 
tion had been drawn to it. 
In the clinical study of the bronchial type we meet with a variety and 
a want of constancy in the symptoms. These may be said to depend on 
what may be called the intensity of the disease; still there is a certain 
similarity, and certain symptoms will be found to correspond closely to 
the presence of certain physical signs in such a way that the diagnosis 
cannot be doubtful. The disease usually commences suddenly in pre- 
vious good health, with a severe chill or chilliness; this is followed by 
fever, which may only last from twelve to twenty-four hours. The 4 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
fever may assume a remittent or an intermittent character, and may be 
interchangeable with hot flushes and chilly sensations. The tongue is 
usually clean, very rarely coated or furred. There may be a violent 
headache, with pains in the limbs and back; the pains in the back are 
especially about the coccyx, radiating into the pelvis and thighs. In 
some cases the pain is in the lumbar region; there is a stiffness of the 
joints and a soreness and tenderness of the muscles, with a general con- 
dition of great lassitude and prostration. Great dejection, low spirits 
with drowsiness, is a frequent symptom. The headache is often first 
frontal, then following the longitudinal sinus to the occiput; at times it 
is rather a feeling of fulness than pain. The body is often covered with 
profuse perspiration during the high fever ; cold sweats alternating with 
hot flushes are very often seen. The superficial veins are swollen and 
engorged with very dark blood; this was especially noticeable in the 
tortuous, swollen temporal vein and the veins of the forearm. There is 
a cough, usually of a violent paroxysmal character, and a profuse dis- 
charge of a clear, viscid fluid. This fluid is so viscid that in some cases 
the cup may be inverted and the secretions will hang as a string. In 
some cases we find, instead of a paroxysmal cough, an incessant hacking 
cough, with a thick, viscid secretion that is expectorated with great 
difficulty. Marked inspiratory stridor, resembling that of spasmodic 
laryngitis, or whooping-cough, is often seen, the paroxysm ceasing with 
retching and the expectoration of viscid fluid. The coygh is frequent 
at night, especially on lying down, and in the early morning hours. In 
children the secretion is often wanting, and the cough has a deep, brassy 
tone. Pulmonary hemorrhage is often one of the earliest symptoms. 
This may be a simple discoloration of the sputa, or it may be pure 
blood; it is usually recurrent, at intervals of several days. In other 
cases the hemorrhages recur at intervals of weeks or months. 
Physical Signs.—On examining the lungs we find the changes in the 
respiratory sounds characteristic and pathognomic of the condition of 
the'lungs. The inspiration is lengthened, sharp, and of a high pitch, and 
immediately followed by a prolonged expiration of a lower pitch. This 
respiratory sound greatly resembles that heard in the first stage of 
asthma; the pitch, however, is higher.1 In the earlier stages the inspira- 
tion is very prolonged, suggestive of a difficult lung expansion, with a 
short expiration of a lower pitch ; there is an absence of the normal 
susurrus, and it is harsher and sharper than normal respiration. Later 
the inspiration becomes harsh, high-pitched, and shorter, followed by 
an expiration which is softer and of lower pitch. In some cases the 
harsh inspiration is alone heard, the expiration being absent. This 
1 William C. Glasgow : The Etiology and Mechanism of Asthma. American Journal 
op the Medical Sciences, July, 1887. GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
5 
peculiar respiration I believe to be due to the swollen, infiltrated condi- 
tion of the bronchial mucous membrane—the same solid oedema of the 
mucous membrane that we see in the fauces in similar cases. Where 
the areas of consolidation exist, the harsh respiration gives place to the 
true bronchial respiration. In all cases we find this type of breathing 
present. In many cases we find the respiratory sound covered by the 
sonorous and sibilant rales. In some cases the whistling rales and the 
wheezing with the oppression resemble an attack of asthma. These 
are always transient in character; variations occur from hour to hour. 
Occasionally we find mixed with the inspiratory sound large-sized, sub- 
crepitant rales of a dry character. These rales are heard in only a 
certain number of cases, on expiration as well as on inspiration. The 
rapid and striking modifications and changes in these respiratory 
sounds are noticeable features of the disease. The rales come and go, 
and the respiratory sounds vary in different degrees of harshness and 
softness. Striking and rapid changes may take place within a few 
hours. In some cases respiratory sounds are scarcely audible—in fact, 
there is a complete silence. This may continue for hours, when the 
characteristic breathing will be heard. 
Percussion gives a peculiar wooden or deadened percussion sound, in 
which the pulmonary resonance is still recognizable, bid the sense of resist- 
ance is greatly increased. In some cases the wooden percussion note has 
a distinct tympanitic charactei’. If areas of consolidation are present, 
the complete dulness of consolidation will be apparent over those areas. 
There is always increased vocal resonance, or, rather, vocal shock, with 
increased pectoral fremitus, over that part of the lung where the deadened 
percussion sound is found. 
The abnormal physical signs may be summarized as follows: a 
deadened percussion sound, increased vocal and pectoral fremitus, a 
harsh inspiration of high pitch, followed by an expiration of lower 
pitch, with the occasional presence of the dry and moist rales. 
In comparing the physical signs of this condition with those of' an 
ordinary bronchitis, we find this difference : 
Bronchitis. 
Percussion normal. 
Vocal fremitus and pectoral fremitus 
normal. 
The inspiration may be harsh, often 
feeble, but with no change of ex- 
piration. 
Sonorous and sibilant rfiles heard 
both on inspiration and expiration. 
Constancy of abnormal sounds 
during attack. 
Bronchial Type. 
Percussion deadened; increased re- 
sistance; occasionally tympanitic. 
Vocal and pectoral fremitus in- 
creased. 
Inspiration harsh and high-pitched, 
with prolonged expiration of lower 
pitch. 
Rfiles largely inspiratory. 
Sudden and frequent variations ot 
the abnormal sounds. 6 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
These characteristic sounds may continue from a few hours to several 
weeks. The usual time is between two and four days; when they con- 
tinue into the third week it is probable that the tubercular process has 
been added to the original disease. Resolution usually takes place 
rapidly, and the abnormal physical signs are quickly replaced by the 
normal signs. There is often, however, a noticeable tendency towar.d 
relapse, and we see often after a few days, weeks, or months, a return of 
the abnormal physical signs with the presence of more or less of its 
symptoms. 
In the parenchymatous type the disease usually commences with a 
chill, followed by fever. The thermometer usually ranges between 101° 
to 103° or 104° ; in some cases reaches as high as 105°. The fever con- 
tinues with morning remissions and evening exacerbations, but there is 
no strict regularity in its course. In some days we will find the highest 
temperature during the midday hours, or it may vary from hour to 
hour or day to day without any regularity. In fact, this want of'a 
systematic regular course of the fever is one of the striking character- 
istics of the disease. The general height of the temperature varies 
greatly every few days without any appreciable cause. It will continue 
high for three or four days ; then a remission of two or three degrees will 
take place, and again a high temperature will commence. During the 
remissions there may be repetitions of the chilly sensations, or hot and 
cold flushes. The fever continues to the end of the disease, and ends 
gradually by lysis. There is a marked absence of the crisis seen in 
croupous pneumonia. 
In the first days of the attack the patient has a quiet and placid look, 
and the absence of subjective symptoms is very noticeable. The tongue is 
remarkably moist, healthy, in some cases slightly covered with fur in the 
middle; the dry typhoid tongue is a rarity. There maybe no cough and 
no pain in the side; headache, with a feeling of great lassitude, may be the 
only subject of the complaint. In some cases, rheumatoid pains in the 
limbs and in the back are present. The breathing is quiet, although the 
respiration is invariably increased. The ratio between pulse, respiration, 
and temperature shows a constant change and irregularity. Transient 
attacks of a feeling of oppression or suffocation come on, but these rarely 
last for any length of time. Later, the patient may experience great 
pain and tenderness in the lower border of the chest, about the upper 
border of the liver and spleen. This pain in some cases is very intense, 
and may last for twelve hours ; it then disappears to reappear again at 
the same or some other place. I have known this pain to recur at 
irregular intervals during convalescence. It is entirely dissimilar from 
the nipple pain seen in croupal pneumonia. It is a myalgia not a 
pleural pain, and in some cases is widely In some cases it 
seems essentially neuralgic. During the whole course of the disease the GLASGOW, UNUSUAL FORM OF LUNG DTSEASE. 
same expression of content and well-being may continue in the face. 
There is no cyanosis or noticeable action of the accessory muscles of 
respiration. The skin is of a dirty white color, and, in some cases, 
tinged with yellow. The pulse is generally accelerated; not, however, 
to a marked degree. It usually varies from 100 to 110 ; in some cases 
it has risen to 120. It is full, or half full, and very compressible. I 
have noticed a marked slowness in several cases, and this continued up 
to the time of death. In one case where I happened to be present as the 
patient expired I could feel the slow, half full, very compressible pulse 
to the last. When it ceased at the wrist it could still be felt for a few 
seconds in the carotids, while the patient remained conscious and ex- 
pired with a few gasping respirations. Profuse perspirations are very 
marked. In some cases they occur during the height of the fever, and 
again are seen like cold sweats. 
On the second or third day a cough comes on with the expectoration 
of a viscid, ropy secretion. In some cases this occurred in great quan- 
tities ; in others it was scanty, and expectoration consisted of rounded, 
isolated masses of a substance resembling mucine. These masses were 
usually expectorated with great difficulty. The cough is, as a rule, a 
full, free cough—what may be called a tracheal cough, and is caused by 
the effort to expel the accumulating secretions. Occasionally it occurs 
in paroxysms. In some cases blood was mixed with the expectorated 
secretion, and it had a strong resemblance to the rusty colored sputa 
peculiar to croupous pneumonia. The color, however, is rather darker, 
and pure blood is almost always present in these cases. In some cases 
free hemorrhage has been seen ; in fact, it has occurred on the onset of 
the disease. The blood is usually dark, and is often mixed with black 
clots. When the hemorrhage occurs it is generally recurrent, appearing 
at intervals of one, two, or more days. The hemorrhage may be in 
amount from half a drachm to a pint. In one case, an infant of seven 
months, a large hemorrhage produced death. The child had been ill 
two months with a pneumonia contracted in California. It is a notice- 
able fact that the viscid secretion always ceased with the appearance of 
a pure hemorrhage, and again reappeared later. In the later stages the 
viscid sputa shows a purulent character, this continuing for days or 
weeks. The purulent sputa may, however, disappear for a time, to be 
again replaced by the clear, viscid sputa. As the disease progresses, 
diu'ing recovery, a muco-purulent secretion is observed. The history 
and varying changes in the character of the sputa are most inter- 
esting and remarkable characteristics of the disease. The causes of 
these changes are unknown, as there is nothing in the clinical history 
that can account for them. In fatal cases, in the last days there is an 
absence of the cyanotic condition seen in croupous pneumonia. The 8 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
death is quiet and peaceful; it may occur at the most unexpected times, 
and at times when the patient shows most favorable symptoms. 
Physical Signs.—On percussion, even in the first days of the attack, 
a deadened or a wooden percussion sound is generally apparent over parts 
of both lungs ; over irregular areas of either one or both lungs we find a 
more complete dulness, almost flatness. The most frequent site of the 
flatness is the posterior portion of the lower part of the left upper lobe, 
immediately under the lower edge of the scapula. Next to this, the left 
upper apex was most frequently affected. As a rule, several areas of 
flatness were found in each lung. The pectoral fremitus was invariably 
exaggerated over those portions of the lung giving the wooden per- 
cussion sound ; over those portions giving the flat sound it was greatly 
increased. On auscultation over the flat areas bronchial breathing 
could be heard; and over those portions of the lung which gave the 
wooden percussion sound a harsh, high-pitched inspiration, with a pro- 
longed expiration, was always heard with varying degrees of intensity. 
Vocal resonance, or, rather, the vocal shock, was always increased over 
the flat areas, giving a true bronchophony; and over the deadened areas 
a marked increase in the vocal shock was present. As the disease pro- 
gressed the only change in the vocal sounds was seen in the occurrence 
of the adventitious rales. Over the consolidated areas very frequently 
small mucous rales could be heard mixed with the bronchial breathing. 
This occurred both on inspiration and expiration. The sonorous and 
sibilant rales were also heard from time to time in the other portions of 
the lung. In no case was the true crepitant rale heard. The physical 
signs of abscess of the lung were found in two cases, which made a com- 
plete recovery. At times, in some cases, there would be a complete 
dulness on percussion, with increased pectoral fremitus and vocal shock, 
and a complete absence of the respiratory sound over that portion of the 
lung. In a few hours the bronchial breathing would be heard. As 
resolution advanced there was a rapid change in the physical signs. 
The dulness gave place to normal percussion sound, while the increased 
vocal shock and resonance disappeared, and the bronchial breathing 
gave place to a rather harsh vesicular breathing. The rales disappeared 
later than the other physical signs. When resolution was delayed 
the physical signs continued. In many cases amphoric breathing 
would be heard. In two cases this was heard at the apex and in one 
at the angle of the scapula. The post-mortem in these cases showed 
a complete consolidation of lung tissue at these points. During the 
course of the disease attacks of palpitation are quite frequent, with a 
tendency to heart failure. 
It will be interesting and instructive to compare the clinical history 
and the signs of this disease with those found in croupous pneumonia. 9 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
In certain points there is a great similarity, and in others the difference 
is so great that a differential diagnosis would be made. 
Croupous Pneumonia. 
The chill not repeated. 
Fever of a regular type, terminating 
most frequently by crisis. 
Sharp, lancinating pain about the nip- 
ple, disappearing after a few days. 
Cough in early stage constant, pain- 
ful, and suppressed. 
Face distressed in early stage of the 
disease, with red spots on cheeks, 
face becoming cyanotic and livid 
as the disease progresses. 
Pulse hard, rapid, small, becoming 
very much accelerated toward the 
end. 
Respiration in earlier stages quick- 
ened, suppressed, and shallow; in 
later stages deep, labored,and heav- 
ing. 
On percussion a dulness, usually fol- 
lowing the line of the lobes, most 
frequently the lower lobes. Respi- 
ratory sounds mostly normal over 
remaining parts of lung. 
On auscultation the crepitant rale 
heard in early stage; a rale redux 
in later stages. 
Bronchial breathing, gradually be- 
coming broncho-vesicular and ves- 
icular as resolution takes place. 
Sputa small in quantity, always vis- 
cid, almost always rusty colored. 
Death agony prolonged, with labored 
breathing and a general condition 
of cyanosis. 
A sero-fibrinous or fibrinous pleurisy 
occasionally found. 
The Parenchymatous Type. 
The chill repeated, with occasional 
hot and cold flushes. 
Fever irregular, terminating by lysis. 
No pain in the commencement, but 
later through the lungs, and espe- 
cially over the lower lobes. 
No cough at first; later cough on ex- 
pectoration. 
Face has a calm, restful look, usually 
somewhat pale, with rather a dirty 
white color. 
The pulse full, compressible, rarely 
over 120, in some cases very slow. 
Respiration not visibly accelerated. 
Ratio between pulse, respiration 
and temperature irregular. In the 
last stage respiration often quiet 
and slow. 
On percussion a flatness in irregular 
areas, affecting most frequently the 
middle and upper lobes; deadened 
percussion sound over other parts 
of lung, with increased vocal and 
pectoral fremitus. 
The crepitant rale absent; the rale 
redux not recognizable. 
Respiration is bronchial over the dull 
area, and over the remaining por- 
tion of the lung a harsh, high- 
pitched inspiration, with a pro- 
longed expiration of lower pitch 
on resolution changing rapidly to 
the normal respiratory murmur. 
Sputa may be profuse, a clear, viscid 
fluid often mixed with blood—be- 
coming later purulent. 
Death sudden, with a few gasping 
respirations; peaceful. 
Purulent effusions in pleura, pericar- 
dium, and other cavities. 10 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
In the Mullanphy Hospital three cases during convalescence from 
pneumonia died in a state of coma, with paralysis and symptoms of 
meningitis, and one case on post-mortem showed the rupture of a soft- 
ened artery and a blood-clot in the brain. A mild delirium is some- 
times seen with hallucinations. One case during convalescence had 
facial erysipelas with abscess of the eyelids, and later enlargement and 
suppuration of the maxillary glands. In the other, erysipelas preceded 
pneumonia, and the patient died during the latter. In one case an 
attack of pneumonia was followed by peritonitis, to which the patient 
succumbed. In the City Hospital in many cases the symptoms of acute 
nephritis have been added to those of the lung disease. On December 
27, 1889, a patient entered the Mullanphy Hospital with acute neph- 
ritis, suppression of urine, and general anasarca. On the second day 
after admittance he began to expectorate quantities of viscid sputa 
mixed with blood, and on examination the physical signs of broncho- 
pneumonia were found. Gastro-intestinal disturbance has been the 
initial symptom in several cases. Two cases were admitted into the 
City Hospital with such violent vomiting and purging that poisoning 
was suspected. The following day the signs of broncho-pneumonia were 
well developed. Skin eruptions with glandular enlargement have been 
frequently observed. The herpetic eruptions and purulent bullae have 
been most frequent. In one case an erythematous blush over the whole 
body somewhat resembling scarlet fever was observed. Numerous cases 
have complained of violent otalgia, and in many of these there has 
been an oedematous, swollen condition of the external ear. This 
occurred frequently during convalescence. Pericarditis has occurred 
in several cases. The parenchymatous consolidation may continue with 
the usual symptoms and physical signs from five to thirty days, and 
still resolution with recovery may take place. 
That these two classes of cases are types, rather than stages, of the 
same disease is evidenced by the fact that clinical observation has 
proven that the typical condition, as observed, remains through the 
whole course of the disease. In the cases under my observation the 
bronchial type never merged into the parenchymatous, and the paren- 
chymatous type, with its extensive consolidated areas, is observed on 
the first days of the illness. Observation of a certain number of cases 
of both types during the past two years has conclusively proven that 
when the process continues a certain length of time the result in both 
classes of disease is tubercular disease. The period when the tubercular 
process is added to the bronchial pneumonia is still uncertain, but from 
my observation I can safely say that when the symptoms and the phy- 
sical signs continue for one month there is a strong probability that the 
bacillus tuberculosis will be found in the sputa. In a few cases careful 
and repeated examinations of the sputa were made by Dr. E. M. Sen- 11 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
seny in the Mullanphy Hospital, and he finds that the bacillus appears 
about the third week of the disease. The appearance of the bacillus 
coincides in many cases with the change of the sputa from the clear, 
viscid fluid to the viscid, purulent secretion. At this time the expecto- 
ration may become of the typical tubercular type, showing the minute 
white particles, and a microscopic examination reveals the bacillus tuber- 
culosis in enormous numbers. I can, however, mention two cases where 
the consolidation continued six weeks; both these patients recovered; 
no bacillus could be found in the sputa. Some have claimed that the 
bronchial type of cases are simply cases of tubercular disease, but re- 
peated examinations of sputa by Dr. Senseny, and numerous micro- 
scopic examinations with cultures and inoculations of the lung tissues 
made by Dr. Bremer, have positively proved the absence of the tuber- 
cular bacillus in the early stages of the disease. It seems to be pretty 
well established that the condition of lung tissue in this disease proves a 
most fertile soil for the development and growth of the tubercular 
germ. This may account for the fact which I have observed during the 
past few years that the number of persons showing tubercular disease 
has greatly increased, and this is true of persons in whose families no 
hereditary disease or disposition can be found. 
The question of the contagiousness of this disease is still an open one, 
but many facts have occurred that seem at least to suggest it. Last 
winter, when a ward in the Mullanphy Hospital contained four cases 
of this disease, several other cases with different forms of disease began 
expectorating the viscid, gelatinous sputa similar to that of the pneu- 
monic cases, and the viscid sputa did not entirely disappear from the 
ward until the walls had been washed and cleaned. 
I am informed by Dr. Senseny that in the female ward it was noticed 
that the patients occupying the adjoining beds to the pneumonic cases 
seemed to contract the same disease in the mild form. 
In the City Hospital many cases have occurred in the surgical ward, 
where the patients had long been occupants of the hospital, and confined 
to bed by their injuries. 
That the disease is a septic disease cannot be questioned after a con- 
sideration of the post-mortem appearance of the organs. That it is 
primarily due to some change in the blood, possibly the presence of a 
microorganism, seems most probable from a clinical study of the disease. 
The microscope shows the presence of broncho-pneumonic infiltration of 
the lung tissue, but that this is a secondary process is self-evident. No 
local inflammatory disease could be associated with such a disorganized 
condition of the other vital organs, these conditions being essentially 
that produced by sepsis. 
The microorganism causing this septicaemia I must leave others to 
investigate. In this age of bacteriology, with the modern improved 12 
GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
methods of research and investigation, the solution of the problem cannot 
long be delayed. 
In a paper read before the Eleventh Congress of the American Laryn- 
gological Association, held in Washington in June of last year, I read a 
paper entitled “An (Edematous Form of Disease of the Upper Air- 
passages.”1 In this paper I described a peculiar condition of the upper 
air-passages, accompanied by symptoms showing a close similarity to 
those seen in the disease of the lungs described in this paper. The simi- 
larity was especially marked in the nature of the viscid fluid which was 
expectorated, and in the venous engorgement and the character of the 
symptoms. I claimed in this paper that the throat disease was only a 
manifestation of a general constitutional condition, and that a similar 
disease existed in the bronchi and the parenchyma of the lung. I was 
also justified in this conclusion from the fact that in a large number of 
these cases of lung disease the palate and uvula will be found in the 
condition of solid oedema described in my former paper, and I could 
only reasonably conclude that the diseases of the upper air-passages— 
the bronchi and the lung parenchyma—are all different manifestations 
of the same process, varying only in different degrees of intensity. 
In my former article I suggested that probably this disease, from the 
similarity of the symptoms, might be the “ influenza,” so graphically de- 
scribed by Graves, or the “ grippe” of Valleix; but in the absence of any 
definite description of the pathological condition found in influenza, I 
was not justified in so naming it. At the time this paper was written, 
April, 1889, there was no notice of the presence of influenza in any part 
of the globe, and it seems strange that a disease which has always 
occurred in waves, spreading rapidly over large portions of the world, 
should show itself as a sporadic form of disease. However, the throat 
disease described in my former paper and the lung disease the subject 
of this article were not confined to this part of the country. I saw one 
of these cases of septic broncho-pneumonia originating on the Mexican 
Plateau, one in Colorado, one in El Paso, Texas, one in California, and 
one in Galveston, Texas. Cases of the throat disease originated in 
Boston, Brooklyn, New York, Philadelphia, Pittsburg, and New Orleans. 
At the meeting of the American Medical Association in Cincinnati, 1888, 
Dr. Carl Seiler, of Philadelphia, was the only physician of many whom I 
consulted that had recognized the peculiar throat affection. In May, 
1888, Dr. R. P. Lincoln, of New York, described to me an obscure case 
of lung disease he had seen with Dr. Loomis, and from the description I 
recognized one of the cases described in this paper. If this disease is 
the influenza, we have had numerous cases in this country three years 
1 W. C. Glasgow, M.D.: An (Edematous Form of Disease or Septic (Edema of the Upper 
Air-passages. New York Medical Journal, August 10, 1889. GLASGOW, UNUSUAL FORM OF LUNG DISEASE. 
13 
preceding its appearance in Europe. During the winters of 1886, 1887, 
and 1888 they were numerous, and during the past summer and autumn 
a number have been seen in the hospitals of this city. The number of 
cases began largely to increase during December of 1889, and at the 
present time there are a large number in the City and Mullanphy 
Hospitals. During the month of January, 1890, while the epidemic of 
influenza prevailed, large numbers of these cases appeared in St. Louis. 
The greatest number have been of the bronchial type. They have oc- 
curred as a relapse of the influenza one, two, three, four, and six weeks 
after the initial attack. 
Three years ago, when the parenchymatous type of this disease was 
considered as croupous pneumonia, it was treated by the stimulant plan 
usual in this disease. The sudden and great mortality proved the use- 
lessness of this form of treatment. From the success attendant on the 
use of benzoate of soda in the cedematous disease of the upper air-passages, 
I was led to use it in this condition of the lung, and the success and the 
greatly diminished mortality were so striking that I am convinced it is 
the best remedy for this class of cases. My individual experience is in 
accordance with that of the gentlemen in charge of the City Hospital, 
who have found a greatly diminished mortality sinc'e the benzoate of soda 
treatment was introduced. I usually give large doses of the benzoate of 
soda with acetate of ammonia, and supplement this with large doses of 
muriated tincture of iron, with a moderate use of stimulants. The ex- 
cessive use of stimulants is injurious, as at the critical periods the heart 
cannot respond. The addition of the salicylate of soda in some cases to 
the benzoate seems to be useful. In certain cases large individual doses 
of quinine will be necessary to bring down the temperature when it 
becomes too high, and as there is a constant tendency to heart failure 
the use of digitalis and the other heart tonics and diffusible stimulants 
will often be necessary. Careful and constant attention is absolutely 
necessary. Many patients die who might be saved by the timely adminis- 
tration of a stimulant in threatened heart failure. Antifebrin has also 
been used with a certain amount of success in the City Hospital. 
In conclusion, I would publicly express my thanks to Dr. Dalton, 
Superintendent of the City Hospital, who has placed the large material 
of that hospital so freely at my disposal, and also to the physicians in 
attendance at that institution during the past two years. Their interest 
in the investigations of this disease, their post-mortem examinations, and 
their confirmation of the symptoms and physical signs as embraced in 
this paper will strengthen the views I have advanced. My thanks are 
also due to Dr. L. Bremer, Professor of Physiology and Bacteriology 
in the Missouri Medical College, who has assisted at most of the post- 
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