A REMARKABLE RESPIRATION RECORD IN INFANTILE 
PNEUMONIAS 
(Reprinted from the Archives of Pediatrics, March, 1892.) 
BY 
WILLIAM A. EDWARDS, M. D. 
San Diego, California. 
Fellow of the College of Physicians of Philadelphia, American Pediatric and 
Philadelphia Pathological Societies; formerly Instructor in Clinical Medicine 
and Physician to the Medical Dispensary in the University of 
Pennsylvania; Physician to St. Joseph’s Hospital; Associate 
Pathologist to the Philadelphia Hospital, and Member 
Advisory Council for the Section on Diseases 
of Children of the Pan-American 
Medical Congress. x 
H. W., set. twenty-one months, passed through the first 
stages of an acute croupous pneumonia under the care of Dr. 
McHattou, of San Diego, by whom I was called in consulta- 
tion on the third day of the disease. At this visit the right 
lung was consolidated from base to apex, and the left base was 
intensely congested, later running through the stages of 
croupous pneumonia. The axillary temperature was 104. i°, 
the pulse 160, and the respiration 60 to the minute. The 
child survived nine days, during which it was under constant 
supervision. The appended chart will graphically present this 
unusual record. The respirations were counted several times 
by both Dr. James S. Waterman, who was associated in the 
treatment of the case, and myself, so that the correctness of 
the observation is beyond doubt. 
* Read before the San Diego County Medical Society, January 15, 1892. NAME- H.W. AET 2,1 MONTHS-DEC. 91. 
TEMPERATURE. 
RESPIRATION. 
PULSE. In infantile pneumonia it is not unusual to record a respira- 
tion rate of 40, or even 50, as for example the nine charted 
cases of Minot, in Keating’s Cyclopaedia, show respectively a 
maximum respiration record of 40, 50, 48, 48, 53, 48, 36, 38, 
48. The charts presented by Townsend (Archives of Pedi- 
atrics, April, 1889, p. 214) show that in all his eases the 
respiration reached the rate of 40 some time during the disease. 
The highest rate reached in this series was 85. 
The maximum rate presented by our case was 104, and the 
usual rate, 80. For a period of nine days the respirations 
never fell below 45 in a minute, but it was usually recorded at 
the higher rate of 80. It is this remarkable continuance of 
an unusually high respiratory rate that renders the case worthy 
of record. Instances of a respiratory rate in infantile pneu- 
monia which are above the one under consideration have been 
recorded by several observers. Hirst (Annals of Gynaecology 
and Pediatry, December, 1890, p. 168) records a respiration 
rate of 127 in a very young infant, with recovery. The age of 
this child is not given, nor is mention made of the duration of 
this extraordinary respiratory action. Goodhart, in the recent 
edition of his book, says that the respirations may rise to 60 
or 70 a minute. 
The case also illustrates the statement which has been made 
that the child with pneumonia, while breathing very rapidly, 
still breathes with ease in comparison with one affected by 
bronchitis, who presents the same respiratory record. 
The child, of course, used the extraordinary muscles of 
respiration, and the alae nasi were dilated during inspiration 
and were contracted during expiration, a condition that some 
writers have considered pathognomonic of infantile pneumonia. 
The temperature, while not as high as other records, is still 
worthy of consideration from its unusual duration. 
In Winsey’s case, Maryland Medical Journal, July 28, 1888 
(Sajou’s Annual), of pneumonia in a girl aged thirteen, the 
temperature was 1060 F. for sixty hours. He adds that the 
highest recorded temperature with recovery was 107°. Smith 
says that Squire has observed a temperature of 107° F. in a 
fatal case of pneumonia in a child, and Dessau (Archives 
of Pediatrics, December, 1891, p. 656) has noted an initial 
temperature of 107° F., followed by recovery. A11 examina- 
tion of Townsend’s temperature charts shows a continued high temperature of about 104°, with little or no remission. The 
highest temperature reached was 106.20 F. in one instance. 
As is shown by the chart, the pulse-respiration ratio was 
seriously interfered with. Throughout the nine days of illness, 
during which the child was under my direct observation, the 
loss of flesh was very slight, if any at all; nutrition was but 
slightly iuterfered with, aud the child took nourishment with 
evident relish. A symptom that in my experience has arisen 
often enough just before death in children fiom respiratory 
obstruction to merit attention, is the desire and attempt on the 
child’s part to bite the attendants. This condition arose in 
the present case eighteen hours before death, when the little 
fellow made a savage attempt on my hand while taking the 
pulse. I have notes of nine other similar conditions arising 
before death in diphtheria and pneumonia. The patient had a 
sudden convulsion and died apparently from respiratory and 
cardiac exhaustion. We will not discuss here the relation of 
the high temperature to this fatal convulsion.