PNEUMONIA, CATARRHAL, OR BRONCHOPNEUMONIA.
Synonyms.—Lobular pneumonia, ve sicular pneumonia, disseminated pneu monia, broncho-alveolitis, broncho-alve olar catarrh, peribronchitis (Balzer), capillary bronchitis, suffocative catarrh.
Definition. — An inflammation of the terminal bronchus and the air-vesicles which make up a pulmonary lobule.
Varieties.—There are recognized two principal types of the disease: the lobular, in which the dissemination of the mor bid process and the distinctly lobular in volvement of the alveoli can be readily demonstrated, and the pseudolobar, in which the massing and extent of the af fected areas gives a resemblance to the consolidation of croupous or lobar pneu monia. To this may be added that type at one time clinically distinguished as capillary bronchitis.
Symptoms. — As the severity of the pathological processes varies greatly in different cases, the symptoms have corre sponding variability. In some cases the general symptoms are so slight that the patient walks around attending to his usual affairs, or, if a child, plays about, with but slight complaint except of cough, or as is likely to be said of "cold." This is not infrequent at the beginning of an attack of influenza, which may afterward prove quite severe, if unat tended to; and it is the rule in the early stages of tuberculosis. The mistake of looking upon the case as one of simple bronchitis may thus easily be made.
Elevation of temperature, often sur prisingly great, will, however, be discov ered upon thermometrical examination; percussion and auscultation of the chest will reveal some of the characteristic physical signs. There may be slight pain in the chest, especially if there be pleural involvement, and this is more common in influenza and tuberculosis than in other varieties of the affection. In other cases the symptoms, though rarely, ex cept in influenza, sudden in onset, be come quite severe from the first; there is prostration, with high fever, rapid pulse, headache, restlessness, pain in the chest, and respiratory distress, with quickened breathing, cough, and usually expectoration, though in children in whom the morbid process ensues as a sequel of some infectious fever the cough is at first dry and harsh. In infants and
young children, moreover, there is often difficulty or even impossibility of ex pectoration; so that the moist sounds of air passing through the mucus retained in the windpipe and bronchi may be audi ble even to the casual observer; and there is then considerable distress in respiration, often approaching suffoca tion, thus giving rise to the common synonym of capillary bronchitis: suffoca tive catarrh. The matter expectorated is not, as a rule, blood-stained, but varies much in its physical characteristics. It is usually mucoid; sometimes, and espe cially in tuberculosis, muco-purulent; and in influenza often resembles boiled sago sprinkled with coal-dust. I have come to look upon this black discolora tion of the influenzal sputum as quite characteristic. The appetite is impaired, the tongue coated, the lips red and dry at first, afterward cyanotic. The skin is dry and hot.
Physical examination at first, espe cially in children, may fail to reveal dull ness or even blowing breathing, but there will be discovered, scattered over both lungs and often more frequent and more extensive at the bases, showers of fine subcrepitant rages. Sibilant rhonchi may likewise be heard. In the course of a day or two, sometimes later, scattered areas of dullness associated with bron chial or vesiculo-bronchial breathing, and moist riles, and sometimes with ab sence of breath-sounds, indicating atelec tasis, are discovered. Of these some are constant and others appear and disap pear: shifting dullness. They may be numerous and small or few and extensive; sometimes they are massive, involving the greater portion of a lobe or of a lung. These massive areas are constant, and over them the breathing is distinctly bronchial, closely resembling that of lobar pneumonia. Bronchophony may be present. In tuberculosis, what I have termed "the isolated apex sibilant rale" is quite characteristic. An apex pleuritic friction is sometimes heard; and usually as the ease progresses there develop char acteristic crackling, and the liquid rides indicative of softening.