The associated pathology of broncho pneumonia presents but few special feat ures apart from those of the diseases which it complicates. The pleura is al most invariably inflamed when the pneu monia reaches the surface, but effusion to any extent is not common. It is not, however, affected over collapsed portions, and, when these are superficial, the state of the pleura may aid in the diagnosis between collapse and pneumonia. The bronchial glands are swelled and medul lary-looking. Sometimes they are dis tinctly hyperemic, but, when the swell ing is extreme, they may be pale. In a few cases they are unaffected. Some times cheesy spots or calcified nodules are found in them, but these usually accom pany tubercles in the lung.
The dilatation of the right side of the heart, resulting from obstruction to the pulmonary circulation, may lead to per sistence of the openings of the foramen ovale and ductus arteriosus. Thrombo sis of the pulmonary artery is occasion ally observed. Pericarditis is also an oc casional complication.
The appearances observed in other or gans are, for the most part, the result of venous congestion. Udema and conges tion of the brain are common in fatal cases. Meningitis of the base is a rare complication. The liver is congested, and hyperaemia and catarrh of the stom ach and intestines are also common. In the large intestines the catarrhal conges tion may even give rise to dysenteric changes. The kidneys are also congested, and concretions of orates are often found in the straight tubules of the pyramids. General dropsy is an occasional compli cation.
Treatment.—While to some extent de pendent upon the exciting cause of the pathological process in the individual case, and subject to modification accord ing to age, sex, personal characteristics, environment, and so forth, the general lines of treatment in cases of broncho pneumonia are very much alike in all cases.
In the acute form of the disease rest is necessary, and, if the process be severe, rest in bed. Sufficient ventilation with out exposure of the patient to draft is a necessity; and, in general, the tempera ture of the sick-room should be kept as near 70° F. as possible. When the pa tient is aged, or in the case of capillary bronchitis in children, a higher tempera ture, even to SO° F. is sometimes neces sary. In capillary bronchitis, too, the air of the room should be kept moist by the evaporation of water, on which aromatic or terebinthinate substances (eucalyptol, menthol, etc.) may be thrown so that their vapors may be pleasantly and equa bly diffused.
Antiseptic steam inhalations objected to. They are a source of a great deal of harm, for they do not reach the seat of the disease and disinfect the local proc ess, while they keep the air of the room surcharged with moisture and usually at a high temperature. If a Avell per son should stay in a room twenty-four hours where there was a boiling kettle saturating the air with carbolic acid, compound tincture of benzoin, or some such substances as were so commonly used, he would begin to realize how enormously debilitating it is. Oxygen
is useful. Herman W. Biggs (Med. Rec., Mar. 16, '96).
The plan in the treatment of cases of broncho-pneumonia is to put children in a room warmed to 75° F. or above, to keep a kettle of water boiling in the room, and on the kettle to keep a ves sel of beech-wood creasote or pine-needle oil, care being taken that the creasote does not boil down and become too pun gent. One seldom needs cough-syrups or expectorants in such an environment. George M. Swift (Archives of Ped., Apr., '96).
Hot flaxseed poultices applied over the affected area, or, when the process is wide-spread, over the entire chest, front and back (jacket poultice), are of great service. The poultice should be well made by slowly stirring boiling water into successive portions of flaxseedmeal, and the mixture should then be spread be tween two layers of cheese-cloth. Oiled silk should be applied over the poultice, and the whole kept in place neatly by pins or bandage. Well made, properly applied, the poultice should retain its heat from four to six hours. From two to three poultices are to be applied dur ing the day, and "at bed-time" the skin is to be well dried and sponged with alcohol and alum, and the chest is en veloped in a jacket of lambs' wool. The following day and the third day, if neces sary, the poultices are reapplied, the lambs' wool being again substituted at night. It is rarely advisable to continue poulticing longer than this. In some cases poulticing may be preceded by counter-irritation. The best method of counter-irritation is by means of a mild mustard plaster, made with the addi tion of glycerin and white of egg. This can be retained in position for an hour or two without bad effect. In children it is better to rub the chest with amber-oil night and morning. Sometimes the lambs' wool or cotton jacket may be ap plied immediately, or following upon the counter-irritation without the use of poultices. Considerable pain in the chest, wide-spread, or massive, consolida tion or blocking of the air-vesicles con stitute the indication for the use of poultices. In tuberculous cases, and when for any reason poulticing cannot be properly carried out, dry heat by means of hot-water bag, salt bag, etc., or moist heat by hot compresses may be sub stituted. The application of ice to the chest is strongly urged by some writers, and Mays has recently undertaken a collective investigation, cases of both croupous and catarrhal pneumonia being included in his reports, which are ex ceedingly favorable. I do not employ the ice-pack in bronchopneumonia; but in tuberculous cases when the temperature exceeds 100° an ice-bag over the heart should be applied.