Approximately ten years ago scattered reports began to appear in the foreign literature concerning certain lobular pneumonias of atypical character and distribution associated with unusual clinical findings. Later reports appearing in the American literature (Bowen, Allen, Reimann, Goodpasture and others) established the disease as a new clinical entity of characteristic symptomatology, course, and laboratory findings. Excellent discussions of the clinical and roentgen findings in this disease are to be found in the recent medical literature, but certain features, it is believed, have either escaped notice or have not received the attention they deserve. The observations which are the subject of this paper are derived from a study of approximately 1,500 pneumonia patients admitted to the AAF Regional Station Hospital of the Santa Ana Army Air Base over a period of two years. Of these, approximately 1,200, or 80 per cent, have been clinically classified as suffering from “primary atypical pneumonia.” All have had interval roentgen studies. For the purpose of accurate analysis, the roentgen findings in 300 of these cases have been carefully tabulated. Clinical Aspects One of the most striking features of primary atypical pneumonia, at least to the radiologist, is the relatively mild clinical course of the disease as compared with the amount of infiltration shown on corresponding chest films. In one series of 26,448 routine 4 × 10-inch photoroentgen examinations of the chest on supposedly healthy young adults applying for air crew training, 153, or 0.58 per cent, showed varying degrees of infiltration, usually small in amount, but occasionally occupying as much as one-fourth of a lung field. The findings were confirmed by recheck 14 × 17-inch films, and the subsequent clinical classification was almost invariably primary atypical pneumonia. When questioned, many of these men reported no symptoms of any kind. Others complained only of a recent “cold” or “cough” or of feeling weak, easily fatigued, or “under par.” Patients admitted to the hospital because of a more acute or severe illness complained primarily of fever and chills, cough, general malaise, weakness, and various aches and pains. The onset was usually moderately acute over a period of one to three days. Cough, either dry or productive of slight mucoid sputum, was present in most cases, and was often the outstanding symptom, complained of bitterly because of its persistent, irritating character. A sensation of extreme weakness, fatigue, or exhaustion was one of the most pronounced and also one of the commonest findings. In mild cases, it was sometimes the only symptom. There was often accompanying moderately severe and persistent headache, general aching, or both. Sore throat was frequently present but was seldom severe or the presenting symptom. Chills or chilly sensations and profuse perspiration were encountered commonly, especially in the early stages of the disease.
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